NPIMap

Organization Active NPI

Credo Community Center for the Treatment of Addictions

  • Substance Abuse Rehabilitation Facility
  • Evans Mills, NY
National Provider Identifier
1740695568
Registry record updated Jul 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
141011632 Issued in NY
Legal business name
CREDO COMMUNITY CENTER FOR THE TREATMENT OF ADDICTIONS
Practice address
24180 County Route 16
Evans Mills, NY 13637-3127
Phone
(315) 788-1530
Fax
(315) 788-3794
NPI assigned
Jul 1, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2014

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

Authorized official

Name
James P Scordo, CASAC
Title
Executive Director
Phone
(315) 788-1530

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 141011632 NY Primary

Addresses

Primary practice location

24180 County Route 16
Evans Mills, NY 13637-3127

Mailing address

595 W Main St
Watertown, NY 13601-1335
Phone (315) 788-1530

Other identifiers 1

IdentifierTypeStateIssuer
02996752MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Credo Foundation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

24180 County Route 16
Evans Mills, NY 13637
Phone (315) 629-4441

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404172800000",
    "number": "1740695568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 W MAIN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011335",
            "telephone_number": "315-788-1530",
            "fax_number": "315-788-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24180 COUNTY ROUTE 16",
            "city": "EVANS MILLS",
            "state": "NY",
            "postal_code": "136373127",
            "telephone_number": "315-788-1530",
            "fax_number": "315-788-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDO COMMUNITY CENTER FOR THE TREATMENT OF ADDICTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-01",
        "last_updated": "2014-07-01",
        "status": "A",
        "authorized_official_last_name": "SCORDO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-788-1530",
        "authorized_official_credential": "CASAC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NY",
            "license": "141011632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02996752",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans Mills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2014; 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.