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
55 SINPATCH RD, WASSAIC, NY 12592-2410
(518) 402-4333
Mailing address
44 HOLLAND AVE, ALBANY, NY 12229-0001
(518) 402-4333
(518) 473-1874
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
0275786
NY
Other
Enumeration date
04/29/2009
Last updated
04/29/2009
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