1780882373 NPI number — MHA IN ULSTER COUNTY, INC.

Table of content: (NPI 1780882373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780882373 NPI number — MHA IN ULSTER COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MHA IN ULSTER COUNTY, 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:
1780882373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12402-2304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-336-4747
Provider Business Mailing Address Fax Number:
845-336-0192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 TUYTENBRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE KATRINE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12449-5417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-336-4747
Provider Business Practice Location Address Fax Number:
845-336-0192
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PENDEGAR
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
845-336-4747

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , 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: 02711441 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01309966 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01248324 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01405870 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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