Organization
CREST MANOR LIVING AND REHABILITATION CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALAN JOHN BARTHOLOMEW SR. LNHA (ADMINISTRATOR)
(585) 223-3633
Entity
Organization
Contact information
Practice address
6745 PITTSFORD PALMYRA RD, FAIRPORT, NY 14450-3343
(585) 223-3633
(585) 425-2961
Mailing address
6745 PITTSFORD PALMYRA RD, FAIRPORT, NY 14450-3343
(585) 223-3633
(585) 425-2961
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2762301N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00355519
—
NY
01
—
106012CI
PREF. CARE
NY
01
—
CM
EXCELLUS
NY
01
—
P015005983
BLUE CHOICE
NY
Enumeration date
06/30/2005
Last updated
01/31/2017
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