Organization Name: | CONIFER PARK, INC. |
NPI Number: | 1730379504 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BARBARA A PETTEYS (DIRECTOR OP BILLING) |
Mailing Address: | 323 Lake Hill Road Hawley Cottage, 1st Floor Burnt Hills |
State: | NY US |
Postal Code: | 120279772 |
Phone Number: | 5183998182 |
Fax Number: | 5183727064 |
NPI Enumeration Date: | 07/27/2007 |
NPI Last Update Date: | 03/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | 081110730 |
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: |