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Organization

FCCNYSARC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MATTHEW JOHNSTON (CFO)
(518) 773-7931
Entity
Organization

Contact information

Practice address
465 N PERRY ST, JOHNSTOWN, NY 12095-1014
(518) 773-7931
(518) 725-2850
Mailing address
465 N PERRY ST, JOHNSTOWN, NY 12095-1014
(518) 773-7931
(518) 725-2850

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00931282
NY
Enumeration date
01/12/2007
Last updated
07/31/2008
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