Organization
STATE OF NEW YORK
Active
Parent organization
STATE OF NEW YORK
Other names
Taconic DDSO
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
22 SINPATCH RD, WASSAIC, NY 12592-2432
(518) 402-4333
(518) 408-2465
Mailing address
44 HOLLAND AVE, ALBANY, NY 12208-3411
(518) 402-4333
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0275791
NY
Other
Enumeration date
10/03/2012
Last updated
10/03/2012
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