Organization
TULLY HILL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE L VORMWALD CPA (CONTROLLER)
(315) 696-6114
Entity
Organization
Contact information
Practice address
5821 ROUTE 80, TULLY, NY 13159-1116
(315) 696-6114
(315) 696-8509
Mailing address
PO BOX 1116, TULLY, NY 13159-1116
(315) 696-6114
(315) 696-8509
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01805967
—
NY
Enumeration date
01/02/2007
Last updated
04/22/2014
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