1417147273 NPI number — ARMS ACRES, INC.

Table of content: (NPI 1417147273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417147273 NPI number — ARMS ACRES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARMS ACRES, 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:
1417147273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1841
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12201-1841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-952-8408
Provider Business Mailing Address Fax Number:
518-399-6860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 BROADWAY, ROUTE 9W
Provider Second Line Business Practice Location Address:
PORT EWEN EDUCATION CENTER, 1ST FLOOR
Provider Business Practice Location Address City Name:
PORT EWEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12466-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-339-8707
Provider Business Practice Location Address Fax Number:
845-339-2610
Provider Enumeration Date:
07/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE-MOORE
Authorized Official First Name:
PATRICE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR, LIBERTY MANAGEM
Authorized Official Telephone Number:
888-227-4641

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  100210666 , 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: 01420795 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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