1437238706 NPI number — COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF SULLIVAN CO., INC.

Table of content: (NPI 1437238706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437238706 NPI number — COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF SULLIVAN CO., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF SULLIVAN CO., 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:
6
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:
1437238706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 HAMILTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12701-1319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-794-8080
Provider Business Mailing Address Fax Number:
845-791-1716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 HAMILTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12701-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-794-8080
Provider Business Practice Location Address Fax Number:
845-794-8343
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRIGGS-BOLLING
Authorized Official First Name:
IZETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
845-794-8080

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 190343 . This is a "MAGELLEN HEALTH SERVICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02527026 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12676 . This is a "BEACON HEALTH STRATEGIES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A469242 . This is a "OXFORD HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 992155 . This is a "MVP HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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