Organization
KELLY HANNON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVONNE PASQUALICCHIO (REGIONAL MANAGER)
(845) 564-9853
Entity
Organization
Contact information
Practice address
1607 ROUTE 300, NEWBURGH, NY 12550-1738
(845) 564-9853
(845) 564-6974
Mailing address
1607 ROUTE 300, NEWBURGH, NY 12550-1738
(845) 564-9853
(845) 564-9853
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
009353
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009353-1
OT LICENSE
NY
Enumeration date
09/19/2006
Last updated
07/15/2008
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