Provider Demographics
NPI:1902133838
Name:FAIRPORT BAPTIST HOMES ADULT CARE FACILITY
Entity Type:Organization
Organization Name:FAIRPORT BAPTIST HOMES ADULT CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOYTASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-388-2303
Mailing Address - Street 1:4646 NINE MILE POINT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1163
Mailing Address - Country:US
Mailing Address - Phone:585-388-2303
Mailing Address - Fax:585-377-2620
Practice Address - Street 1:4646 NINE MILE POINT RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1163
Practice Address - Country:US
Practice Address - Phone:585-388-2303
Practice Address - Fax:585-377-2620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRPORT BAPTIST HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility