Organization
LEROY VILLAGE GREEN RESIDENTIAL HEALTH CARE FACILITY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA A HUBBARD (ACCOUNTS RECEIVABLE)
(585) 502-0467
Entity
Organization
Contact information
Practice address
10 MUNSON ST, LE ROY, NY 14482-8933
(585) 768-2561
(585) 502-0470
Mailing address
10 MUNSON ST, LE ROY, NY 14482-8933
(585) 768-2561
(585) 768-4335
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1823300N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000312000
BC BS WNY
NY
05
—
00356345
—
NY
01
—
105536C1
PREFERRED CARE
NY
01
—
76
INDEPENDENT HEALTH
NY
01
—
P015001901
BCBS ROCHESTER
NY
Enumeration date
10/25/2005
Last updated
01/18/2012
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