Provider Demographics
NPI:1194060566
Name:ROCHESTER REHABILITATION CENTER
Entity type:Organization
Organization Name:ROCHESTER REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCVEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-271-2520
Mailing Address - Street 1:1000 ELMWOOD AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3042
Mailing Address - Country:US
Mailing Address - Phone:585-271-2520
Mailing Address - Fax:585-295-6070
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3042
Practice Address - Country:US
Practice Address - Phone:585-271-2520
Practice Address - Fax:585-295-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079663251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10714BOtherMEDICAID ID UNSPECIFIED
NY00357497Medicaid
NYMDG569OtherPREFERRED CARE
NY0010182152OtherBLUE CHOICE
NYMDG569OtherPREFERRED CARE