Organization
STATE OF NEW YORK
Active
Organization
STATE OF NEW YORK
Active
Parent organization
STATE OF NEW YORK
Other names
CAH Sunmount DDSO
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF NEW YORK
Authorized official
EARL JEFFERSON (DIRECTOR OF CENTRAL OPERATIONS)
(518) 402-4333
Entity
Organization
Contact information
Practice address
2445 STATE ROUTE 30, TUPPER LAKE, NY 12986-2502
(518) 457-9835
Mailing address
44 HOLLAND AVE, ALBANY, NY 12229-0001
(518) 402-4333
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
CAH00018
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01361182
—
NY
Enumeration date
12/31/2007
Last updated
07/21/2015
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