Organization
STATE OF NEW YORK
Active
Parent organization
STATE OF NEW YORK
Other names
West Seneca DC Crestview ICF
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF NEW YORK
Authorized official
KARLA SMITH (DIRECTOR OF CENTRAL OPERATIONS)
(518) 402-4333
Entity
Organization
Contact information
Practice address
510 LEYDECKER RD, WEST SENECA, NY 14224-3731
(518) 402-4333
Mailing address
44 HOLLAND AVE, ALBANY, NY 12229-0001
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
00229630
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00745919
—
NY
Enumeration date
02/07/2007
Last updated
06/26/2008
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