# CRESTWOOD CHILDREN'S CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346576568
- **Authorized official:** MR. GARY ANTINONE (ACCOUNTS RECEIVABLE)
- **Authorized official phone:** (585) 654-1418

## Contact information

- **Practice address:** 1183 MONROE AVE, ROCHESTER, NY 14620-1662
- **Practice address phone:** (585) 654-1418
- **Practice address fax:** (585) 654-1450
- **Mailing address:** 1183 MONROE AVE, ROCHESTER, NY 14620-1662
- **Mailing address phone:** (585) 654-1418
- **Mailing address fax:** (585) 654-1450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 10/22/2009
- **Last updated:** 10/22/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00788041 | — | NY |