State of New York
Organization
Active NPI
Intellectual Disabilities Intermediate Care Facility · Pinebush, NY
NPI 1437299641 · NPPES record last updated Jun 26, 2008
Key facts
- NPI
- 1437299641
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- License
- 00271987 (NY)
- Legal business name
- STATE OF NEW YORK
- Practice address
- RR #1 Box 269B
Pinebush, NY 12566
- Phone
- (518) 402-4333
- NPI assigned
- Feb 7, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- STATE OF NEW YORK
Authorized official
- Name
- Karla Smith
- Title
- Director of Central Operations
- Phone
- (518) 402-4333
Corporate family (same tax ID) 24
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National Provider Directory
- Tax ID family
- Daniel a Spengler (269 organizations share this tax ID)
- Part of
- Daniel a Spengler
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Intellectual Disabilities Intermediate Care Facility |
315P00000X |
00271987 |
NY |
Yes |
Addresses
Primary practice location
RR #1 Box 269B
Pinebush, NY 12566
Mailing address
44 Holland Ave
Albany, NY 12229-0001
Phone (518) 402-4333
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 01008759 | Medicaid | NY | |
Other names
- Letchworth DC Blackhawk ICF Other name