NPIMap

Organization Active NPI

Upstate Cerebral Palsy, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Utica, NY
National Provider Identifier
1790846780
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
02007638 Issued in NY
Legal business name
UPSTATE CEREBRAL PALSY, INC
Practice address
1237 Tilden Ave
Dimeo Residence
Utica, NY 13501-4150
Phone
(315) 798-9275
Fax
(315) 734-9659
NPI assigned
Dec 13, 2006
Last updated
Apr 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

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

Authorized official

Name
Geno Decondo
Title
Executive Director
Phone
(315) 724-6907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 02007638 NY Primary

Addresses

Primary practice location

1237 Tilden Ave
Dimeo Residence
Utica, NY 13501-4150

Mailing address

125 Business Park Dr
Utica, NY 13502-6305
Phone (315) 724-6907

Other identifiers 1

IdentifierTypeStateIssuer
02007638MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790846780. Details of each certification follow.

  • CCN 33H376 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 33H376

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
UPSTATE CEREBRAL PALSY, INC
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jan 4, 2000
Last certification
Jul 30, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
1237 Tilden Avenue
Utica, NY 13501

National Provider Directory

National Provider Directory
Tax ID family
United Cerebral Palsy29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

1237 Tilden Ave
Utica, NY 13501
Phone (315) 798-9275

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680652800000",
    "number": "1790846780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 BUSINESS PARK DR",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026305",
            "telephone_number": "315-724-6907",
            "fax_number": "315-733-0791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1237 TILDEN AVE",
            "address_2": "DIMEO RESIDENCE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135014150",
            "telephone_number": "315-798-9275",
            "fax_number": "315-734-9659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE CEREBRAL PALSY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A",
        "authorized_official_last_name": "DECONDO",
        "authorized_official_first_name": "GENO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-724-6907"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NY",
            "license": "02007638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02007638",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, NY

Sources for this page

Verify at the official NPI Registry.