Organization
FAIRPORT BAPTIST HOMES
Active
Other names
Lifetimes Adult Day Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS H. POELMA (PRESIDENT/CEO)
(585) 388-2300
Entity
Organization
Contact information
Practice address
4646 NINE MILE POINT RD, FAIRPORT, NY 14450-1163
(585) 388-2303
Mailing address
4646 NINE MILE POINT RD, FAIRPORT, NY 14450-1163
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2725300N
NY
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00395657
—
NY
05
—
01703382
—
NY
01
—
105934CI
PREFERRED CARE
—
01
—
105934FQ
PREFERRED CARE 'B'
—
01
—
P015005960
EXCELLUS BC/BS
—
Enumeration date
08/14/2006
Last updated
10/23/2014
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