Organization
NEW YORK STATE
Active
Parent organization
NEW YORK STATE
Other names
TACONIC DDSO
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEW YORK STATE
Authorized official
KARLA J SMITH (DIRECTOR OF CENTRAL OPERATIONS)
(518) 402-4333
Entity
Organization
Contact information
Practice address
51 SINPATCH RD, WASSAIC, NY 12592-2410
(845) 877-3109
Mailing address
44 HOLLAND AVENUE, ALBANY, NY 12229-0001
(518) 403-4333
(518) 408-2465
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
00275789
NY
Other
Enumeration date
07/21/2011
Last updated
07/21/2011
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