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 J SMITH (DIRECTOR OF CENTRAL OPERATIONS)
(518) 402-4333
Entity
Organization
Contact information
Practice address
18 SINPATCH RD, WASSAIC, NY 12592-2432
(518) 402-4333
Mailing address
44 HOLLAND AVENUE, ALBANY, NY 12229-0001
(518) 402-4333
(518) 473-1874
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
00275788
NY
Other
Enumeration date
02/15/2011
Last updated
02/15/2011
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