Organization Name: | UPSTATECEREBRAL PALSY, INC. |
NPI Number: | 1881860633 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GENO DECONDO (EXECUTIVE VICE PRESIDENT) |
Mailing Address: | 10708 N Gage Rd Barneveld |
State: | NY US |
Postal Code: | 133042527 |
Phone Number: | 3158962654 |
Fax Number: | 3158962864 |
NPI Enumeration Date: | 05/01/2008 |
NPI Last Update Date: | 10/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 6282300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |