Organization Name: | CONIFER PARK, INC. |
NPI Number: | 1023208139 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BARBARA A PETTEYS (MANAGER OP BILLING) |
Mailing Address: | 1051 Dix Ave Buildings E And G, 1st Floors Hudson Falls |
State: | NY US |
Postal Code: | 128391053 |
Phone Number: | 5187937273 |
Fax Number: | 5187985004 |
NPI Enumeration Date: | 07/26/2007 |
NPI Last Update Date: | 04/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |