# ESSEX COUNTY CHAPTER, NYSARC, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mountain Lake Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427134451
- **Authorized official:** MR. MARTIN JOSEPH NEPHEW (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (518) 546-3381

## Contact information

- **Practice address:** 10 ST. PATRICK'S PLACE, PORT HENRY, NY 12974
- **Practice address phone:** (518) 546-3051
- **Practice address fax:** (518) 546-3094
- **Mailing address:** 10 ST. PATRICK'S PLACE, PORT HENRY, NY 12974
- **Mailing address phone:** (518) 546-3051
- **Mailing address fax:** (518) 546-3094

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 150901880216 | NY | Yes |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NY | — |

## Other

- **Enumeration date:** 10/31/2006
- **Last updated:** 03/23/2016