NPIMap

Organization Active NPI

Gavia Lifecare Center, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rochester, NY
National Provider Identifier
1710592209
Registry record updated Jun 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
GAVIA LIFECARE CENTER, LLC
Practice address
90 Erie Canal Dr
Rochester, NY 14626-4610
Phone
(585) 371-6464
Fax
(585) 371-6464
NPI assigned
Sep 10, 2020
Last updated
Jun 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maryellen Dance, LMHCNPI 1194004036
Title
Executive Director
Phone
(585) 371-6464

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

90 Erie Canal Dr
Rochester, NY 14626-4610

Mailing address

90 Erie Canal Dr
Rochester, NY 14626-4610
Phone (585) 371-6464

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://gavialifecare.breeze.emr.opusbehavioral.com/#/ Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210427001350 NY Part B Supplier - Clinic/Group Practice 0749697084 Receives reassigned benefits from 10 practitioners
Practice locations: Rochester, NY

National Provider Directory

National Provider Directory

Locations

1081 Long Pond Rd
Rochester, NY 14626
Phone (585) 225-2600

1081 Long Pond Rd
Ste 140
Rochester, NY 14626
Phone (585) 210-0994

1343 Long Pond Rd
Rochester, NY 14626
Phone (585) 371-6464

1343 Long Pond Rd
Ste A
Rochester, NY 14626
Phone (585) 371-6464

90 Erie Canal Dr
Rochester, NY 14626
Phone (585) 225-5883

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782172800000",
    "number": "1710592209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 ERIE CANAL DR",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264610",
            "telephone_number": "585-371-6464",
            "fax_number": "585-371-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 ERIE CANAL DR",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264610",
            "telephone_number": "585-371-6464",
            "fax_number": "585-371-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAVIA LIFECARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-10",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A",
        "authorized_official_last_name": "DANCE",
        "authorized_official_first_name": "MARYELLEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "585-371-6464",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://gavialifecare.breeze.emr.opusbehavioral.com/#/",
            "affiliation": "N",
            "endpointDescription": "Opus",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "90 Erie Canal Dr",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146264610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.