Icc Management & Consulting, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

ICC MANAGEMENT & CONSULTING, INC

Doing business as

The Mansion at South Union

Practice address

11 S Union St
Cambridge, NY 12816-1008

Phone

(518) 677-3711

NPI assigned

Jun 18, 2020

Last updated

Jun 18, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alicia Peek

Title

Business Office Director

Phone

(518) 727-3802

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Mansion at South Union Doing business as

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592438400000",
    "number": "1104442839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1355",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122011355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S UNION ST",
            "city": "CAMBRIDGE",
            "state": "NY",
            "postal_code": "128161008",
            "telephone_number": "518-677-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICC MANAGEMENT & CONSULTING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-18",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A",
        "authorized_official_last_name": "PEEK",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "518-727-3802"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04338327",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Mansion at South Union",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Growing Words, Speech and Language Therapy, PLLC
• Georgianna Hamilton, RN
• Katelynn Hatalsky, MS, PA-C
• Hometown Primary Optometry PLLC
• Peter J Hughes, PT
• William P. Keating, LCSW-R
• Megan M. Kopp, LMHC
• Carissa M Lackey, MD, MPH
• Brooklynn Elaine Lee, MSW
• David Lester, RPH

• Assisted Living Facility in Cambridge, NY
• Providers in Cambridge, NY by specialty
• Assisted Living Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; 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.