State of New York
Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Tupper Lake, NY
NPI 1720127418 · NPPES record last updated Jun 25, 2008
Key facts
- NPI
- 1720127418
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- License
- 00225049 (NY)
- Legal business name
- STATE OF NEW YORK
- Practice address
- 19 Hosley Ave
Tupper Lake, NY 12986 - Phone
- (518) 402-4333
- NPI assigned
- Feb 6, 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
National Provider Directory
- Tax ID family
- Daniel a Spengler
- Part of
- Daniel a Spengler
Locations
19 Hosley Ave
Tupper Lake, NY 12986
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 00225049 | NY | Yes |
Addresses
Primary practice location
19 Hosley Ave
Tupper Lake, NY 12986
Mailing address
44 Holland Ave
Albany, NY 12229-0001
Phone (518) 402-4333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01329157 | Medicaid | NY |
Other names
- Sunmount DDSO SRU #1
Other providers in Tupper Lake, NY
- Jacqueline Corinne Snyder
- Jessica Snyder
- State of New York
- State of New York
- State of New York
- Lisa Rae Tebo
- Tupper Lake Center LLC
- Tupper Lake Central School District
- Tupper Lake Volunteer Ambulance & Emergency Squad Inc
- Walgreen Co
All providers in Tupper Lake, NY · Intellectual Disabilities Intermediate Care Facility in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.