Organization · Type 2 NPI

State of New York

Intellectual Disabilities Intermediate Care Facility · Tupper Lake, NY

NPI number 1205975547 Active

Practice location

Route 3
Tupper Lake, NY 12986

Mailing address

44 Holland Ave
Albany, NY 12229-0001

Specialties and licenses

TaxonomyCodeLicense
Intellectual Disabilities Intermediate Care Facility Primary 315P00000XOMRDD225 (NY)

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

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About NPI 1205975547

State of New York's National Provider Identifier is 1205975547, issued on Feb 5, 2007. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Tupper Lake, NY. The record was last updated on Jun 25, 2008.