1245645324 NPI number — COUNCIL ON ADDICTION RECOVERY SERVICES INC

Table of content: (NPI 1245645324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245645324 NPI number — COUNCIL ON ADDICTION RECOVERY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNCIL ON ADDICTION RECOVERY SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WENDY'S HOUSE SUPPORTIVE LIVING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245645324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 S UNION ST
Provider Second Line Business Mailing Address:
PO BOX 567
Provider Business Mailing Address City Name:
OLEAN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14760-3646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-373-4303
Provider Business Mailing Address Fax Number:
716-373-4327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLEAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14760-3646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-373-4303
Provider Business Practice Location Address Fax Number:
716-373-4327
Provider Enumeration Date:
06/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PRUTSMAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
716-373-4303

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  150910172 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00933817 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030770 . This is a "NYS CHARITIES REGISTRATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 170809255 . This is a "DUNS AND BRADSTREET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 38160 . This is a "OASAS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000816000 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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