State of New York
NPI #1720127418 in Tupper Lake, New York
Provider Information
- NPI Number
- 1720127418
- Entity Type
- Organization
- Organization Name
- State of New York
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- STATE OF NEW YORK
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Feb 6, 2007
- Last Updated
- Jun 25, 2008
Practice Location
- Address
- 19 HOSLEY AVE
- City
- Tupper Lake
- State
- New York
- ZIP Code
- 12986
- Phone
- (518) 402-4333
Authorized Official
- Name
- KARLA SMITH
- Title
- DIRECTOR OF CENTRAL OPERATIONS
- Phone
- (518) 402-4333
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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