Provider Demographics
NPI:1588661326
Name:ONTARIO COUNTY HEALTH FACILITY
Entity type:Organization
Organization Name:ONTARIO COUNTY HEALTH FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-396-4320
Mailing Address - Street 1:3062 COUNTY COMPLEX DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9502
Mailing Address - Country:US
Mailing Address - Phone:585-396-4320
Mailing Address - Fax:585-396-4414
Practice Address - Street 1:3062 COUNTY COMPLEX DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9502
Practice Address - Country:US
Practice Address - Phone:585-396-4320
Practice Address - Fax:585-396-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3429302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103365CIOtherPREFERRED CARE
NYP0150037BTOtherEXCELLUS
NY00303095Medicaid
NY=========OtherFEDERAL TAX ID
NY00303095Medicaid