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Organization
ESSEX COUNTY CHAPTER, NYSARC, INC.
Active
Organization
ESSEX COUNTY CHAPTER, NYSARC, INC.
Active
Other names
Mountain Lake Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN JOSEPH NEPHEW (EXECUTIVE DIRECTOR)
(518) 546-3381
Entity
Organization
Contact information
Practice address
10 ST. PATRICK'S PLACE, PORT HENRY, NY 12974
(518) 546-3051
(518) 546-3094
Mailing address
10 ST. PATRICK'S PLACE, PORT HENRY, NY 12974
(518) 546-3051
(518) 546-3094
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
150901880216
NY
261QD1600X
Developmental Disabilities Clinic/Center
—
NY
Other
Enumeration date
10/31/2006
Last updated
03/23/2016
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