Provider Demographics
NPI:1306901913
Name:ROCHESTER REHABILITATION CENTER, INC
Entity type:Organization
Organization Name:ROCHESTER REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-271-2520
Mailing Address - Street 1:1000 ELMWOOD AVE
Mailing Address - Street 2:
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:585-295-8029
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:
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:585-295-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2701223R251V00000X
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014625950OtherBEHAVIORAL HEALTH BC
NY103335ELOtherCORF PC
NY014635950OtherOCCUPATIONAL THERAPY BC
NY014635950OtherSPEECH THERAPY BC
NY103335FTOtherPHYSICAL THERAPY PC
NY103335FUOtherSPEECH THERAPY PC
NY014555950OtherPHYSICAL THERAPY BC
NY014005950OtherOTHER SERVICES BC
NY0217066Medicaid
NY103335EUOtherBEHAVIORAL HEALTH PC
NY00355317Medicaid
NY014665950OtherPARTIAL HOSP BC
NY103335FROtherOCCUPTATIONAL THERAPY PC
NY5535497OtherCORF AETNA
NY10597AMedicare ID - Type UnspecifiedFREE STANDING CLINIC
NY103335EUOtherBEHAVIORAL HEALTH PC
NY0217066Medicaid
NY00355317Medicaid