1114131075 NPI number — COMMUNITY WORK AND INDEPENDENCE, INC.

Table of content: (NPI 1114131075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114131075 NPI number — COMMUNITY WORK AND INDEPENDENCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY WORK AND INDEPENDENCE, 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:
FOOTHILLS CLINIC
Provider Other Organization Name Type Code:
5
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:
1114131075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 303
Provider Second Line Business Mailing Address:
ACCOUNTING DEPARTMENT
Provider Business Mailing Address City Name:
GLENS FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12801-0303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-745-8084
Provider Business Mailing Address Fax Number:
518-745-1413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 EVERTS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12804-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-793-4700
Provider Business Practice Location Address Fax Number:
518-743-1061
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DONAHUE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
518-745-8084

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X , with the licence number:  02249136 , 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: 55375A . This is a "MEDICARE PROVIDER TRANSACTION ACCESS NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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