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Organization
NEW YORK STATE
Active
Organization
NEW YORK STATE
Active
Parent organization
NEW YORK STATE
Other names
TACONIC 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
51 SINPATCH RD, WASSAIC, NY 12592-2410
(845) 877-3109
Mailing address
44 HOLLAND AVENUE, ALBANY, NY 12229-0001
(518) 403-4333
(518) 408-2465
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
00275789
NY
Other
Enumeration date
07/21/2011
Last updated
07/21/2011
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