1871576934 NPI number — COMMUNITY EMERGENCY CORPS

Table of content: (NPI 1871576934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871576934 NPI number — COMMUNITY EMERGENCY CORPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY EMERGENCY CORPS
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:
Provider Other Organization Name Type Code:
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:
1871576934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 535
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALDWINSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13027-0535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-635-1789
Provider Business Mailing Address Fax Number:
315-635-3289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 GEYSER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLSTON SPA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-885-1478
Provider Business Practice Location Address Fax Number:
518-885-1478
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
518-885-1478

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  09687 , 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: 938658 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000400564001 . This is a "BS OF NORTHEASTERN NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590011775 . This is a "PALMETTO GBA-RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9610659 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01734894 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10021607 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".




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