1902960610 NPI number — ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902960610 NPI number — ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, 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:
1902960610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 FARRELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLSBORO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12996-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-963-4275
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 FARRELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLSBORO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12996-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-963-4275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
518-963-4275

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  1566200R , 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: 00473478 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: FQHCLA218 . This is a "340B ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com