Organization
STATE OF NEW YORK
Active
Parent organization
STATE OF NEW YORK
Other names
Western NY DDSO Gifford Ave A
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
27A GIFFORD AVE, CELERON, NY 14720
(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
00264040
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02558161
—
NY
Enumeration date
02/07/2007
Last updated
06/26/2008
About Stedi
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