1477568822 NPI number — ALTERNATIVE CARE SYSTEMS ,INC

Table of content: (NPI 1477568822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477568822 NPI number — ALTERNATIVE CARE SYSTEMS ,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTERNATIVE CARE SYSTEMS ,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:
1477568822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 KNOLLWOOD ROAD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ELMSFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-747-9696
Provider Business Mailing Address Fax Number:
914-747-7577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 E. 40TH STREET
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-286-9200
Provider Business Practice Location Address Fax Number:
212-682-8025
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEADOCK
Authorized Official First Name:
LOUISE
Authorized Official Middle Name:
Authorized Official Title or Position:
RESIDENT/CEO
Authorized Official Telephone Number:
914-747-9696

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  R1008 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HP0057100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 0108L001 , 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: 5097509 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 530403200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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