Provider Demographics
NPI:1205932167
Name:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Entity type:Organization
Organization Name:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-336-4841
Mailing Address - Street 1:800 CARTER ST
Mailing Address - Street 2:ATTENTION: KELLY STEELE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2604
Mailing Address - Country:US
Mailing Address - Phone:585-339-4793
Mailing Address - Fax:
Practice Address - Street 1:470 LONG POND RD
Practice Address - Street 2:GREECE HEALTH CENTER PHARMACY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3056
Practice Address - Country:US
Practice Address - Phone:585-248-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018428261QH0100X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1307940004Medicare ID - Type UnspecifiedGREECE HLTH CTR PHARMACY