Organization
ESSEX COUNTY CHAPTER, NYSARC, INC.
Active
Other names
Mountain Lake Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN JOSEPH NEPHEW (EXECUTIVE DIRECTOR)
(518) 546-3381
Entity
Organization
Contact information
Practice address
10 ST. PATRICK'S PLACE, PORT HENRY, NY 12974
(518) 546-3051
(518) 546-3094
Mailing address
10 ST. PATRICK'S PLACE, PORT HENRY, NY 12974
(518) 546-3051
(518) 546-3094
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
150901880216
NY
261QD1600X
Developmental Disabilities Clinic/Center
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01276842
—
NY
01
—
03
LOCATOR CODE
NY
01
—
6763301
OPERATING CERTIFICATE #
NY
Enumeration date
10/31/2006
Last updated
03/23/2016
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