Organization
CNYDDSO
Active
Organization
CNYDDSO
Active
Other names
opwdd
Organization subpart
No
Provider details
NPI number
Authorized official
KENT A MYERS (SENIOR OT)
(315) 339-6536
Entity
Organization
Contact information
Practice address
1315 SCHUYLER ST, ROME, NY 13440-2825
(315) 794-4469
Mailing address
1315 SCHUYLER ST, ROME, NY 13440
(315) 794-4469
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
007106-1
NY
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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