# 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:** 1811417827
- **Authorized official:** MR. MARTIN J NEPHEW EXECUTIVE DIRECTOR (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (518) 546-3381

## Contact information

- **Practice address:** 10 ST PATRICK PL, PORT HENRY, NY 12974-1200
- **Practice address phone:** (518) 546-3381
- **Practice address fax:** (518) 546-7138
- **Mailing address:** 10 ST PATRICK PL, PORT HENRY, NY 12974-1200
- **Mailing address phone:** (518) 546-3381
- **Mailing address fax:** (518) 546-7138

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 15090188021 | NY | Yes |

## Other

- **Enumeration date:** 06/21/2017
- **Last updated:** 07/21/2022