Organization
CRESTWOOD CHILDREN'S CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY ANTINONE (ACCOUNTS RECEIVABLE)
(585) 654-1418
Entity
Organization
Contact information
Practice address
1183 MONROE AVE, ROCHESTER, NY 14620-1662
(585) 654-1418
(585) 654-1450
Mailing address
1183 MONROE AVE, ROCHESTER, NY 14620-1662
(585) 654-1418
(585) 654-1450
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00788041
—
NY
Enumeration date
10/22/2009
Last updated
10/22/2009
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