Gustavus Adolphus Child & Family Services

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

GUSTAVUS ADOLPHUS CHILD & FAMILY SERVICES

Practice address

705 Falconer St
Jamestown, NY 14701-1935

Phone

(716) 665-2116

NPI assigned

Oct 9, 2007

Organization subpart

Yes

Parent organization

LUTHERAN SOCIAL SERVICES GROUP, INC.As reported in NPPES

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

Authorized official

Name

Mr. Jason Beckwith

Title

Cfo

Phone

(716) 665-8161

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1023206646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 GUSTAVUS AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147011815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 FALCONER ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147011935",
            "telephone_number": "716-665-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUSTAVUS ADOLPHUS CHILD & FAMILY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN SOCIAL SERVICES GROUP, INC.",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "BECKWITH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "716-665-8161",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00356547",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie Ann Guiher
• Karen T. Gullotti, RPH
• Thomas S. Gullotti, O.D.
• Susan E Gustafson, PA-C
• Tyler Joseph Gustafson, PHYSICIAN ASSISTANT
• Krystal Lee Haenel
• Emily Hair, OTR/L
• Hall Optical
• Kathleen Ann Hall, CCC SLP
• Jamie Lynn Hamm

• Emotionally Disturbed Childrens' Residential Treatment Facility in Jamestown, NY
• Providers in Jamestown, NY by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.