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Organization
STATE OF NEW YORK
Active
Organization
STATE OF NEW YORK
Active
Parent organization
NEW YORK STATE
Other names
Western NY DDSO
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEW YORK STATE
Authorized official
KARLA J SMITH (DIRECTOR OF CENTRAL OPERATIONS)
(518) 402-4333
Entity
Organization
Contact information
Practice address
650 LEYDECKER ROAD, WEST SENECA, NY 14224-3755
(716) 675-1631
Mailing address
44 HOLLAND AVENUE, ALBANY, NY 12224-0001
(518) 402-4333
(518) 408-2465
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
00264080
NY
Other
Enumeration date
08/19/2011
Last updated
08/19/2011
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