# UPSTATE PCA INSTITUTE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881436756
- **Authorized official:** SHANNON GREEN HHA (SUPORVISOR/PROVIDER)
- **Authorized official phone:** (315) 542-4209

## Contact information

- **Practice address:** 1216 GRAY AVE, UTICA, NY 13502-3959
- **Practice address phone:** (315) 542-4209
- **Mailing address:** 1216 GRAY AVE APT 2F, UTICA, NY 13502-3967
- **Mailing address phone:** (315) 542-4209

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 372600000X | Adult Companion | — | NULL | Yes |
| 372600000X | Adult Companion | — | — | Yes |

## Other

- **Enumeration date:** 06/11/2024
- **Last updated:** 07/25/2024