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State of New York

Organization Active NPI Case Management Agency · Tupper Lake, NY

NPI 1083899702 · NPPES record last updated Jul 21, 2015

Key facts

NPI
1083899702
Entity type
Organization (NPI type 2)
Primary specialty
Case Management Agency 251B00000X
License
CAH00018 (NY)
Legal business name
STATE OF NEW YORK
Practice address
2445 State Route 30
Tupper Lake, NY 12986-2502
Phone
(518) 457-9835
NPI assigned
Dec 31, 2007
Organization subpart
Yes
Parent organization (as reported)
STATE OF NEW YORK

Authorized official

Name
Earl Jefferson
Title
Director of Central Operations
Phone
(518) 402-4333

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Daniel a Spengler (269 organizations share this tax ID)
Part of
Daniel a Spengler

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X CAH00018 NY Yes

Addresses

Primary practice location

2445 State Route 30
Tupper Lake, NY 12986-2502

Mailing address

44 Holland Ave
Albany, NY 12229-0001
Phone (518) 402-4333

Other identifiers

IdentifierTypeStateIssuer
01361182MedicaidNY

Other names

  • CAH Sunmount DDSO Other name

Other providers in Tupper Lake, NY

All providers in Tupper Lake, NY · Case Management Agency in New York

Sources for this page

Verify at the official NPI Registry.