1003847740 NPI number — ACCREDITED CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003847740 NPI number — ACCREDITED CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCREDITED CARE, 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:
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:
1003847740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 5TH AVE APT 14A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10003-3055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-989-5306
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 W 3RD ST, STE 705
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14701-5121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-484-7101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRESS
Authorized Official First Name:
FREDRICK
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-989-5306

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  9112L001 , 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: 00900972 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00811032 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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