| Organization Name: | HUDSON HEADWATERS HEALTH NETWORK |
| NPI Number: | 1699056291 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER TOURNIER (CFO / VICE PRESIDENT OF FINANCE) |
| Mailing Address: | 1019 Wicker St Ticonderoga |
| State: | NY US |
| Postal Code: | 128831039 |
| Phone Number: | 5187455936 |
| Fax Number: | |
| NPI Enumeration Date: | 09/09/2011 |
| NPI Last Update Date: | 09/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 5660200R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |