Provider Demographics
NPI:1306254347
Name:INTERIM
Entity type:Organization
Organization Name:INTERIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAGAJLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-978-4424
Mailing Address - Street 1:255 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2625
Mailing Address - Country:US
Mailing Address - Phone:585-978-4214
Mailing Address - Fax:
Practice Address - Street 1:255 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2625
Practice Address - Country:US
Practice Address - Phone:585-978-4214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283595251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management