Provider Demographics
NPI:1013196393
Name:BALDWIN COUNCIL AGAINST DRUG ABUSE, INC. (BCADA)
Entity Type:Organization
Organization Name:BALDWIN COUNCIL AGAINST DRUG ABUSE, INC. (BCADA)
Other - Org Name:BALDWIN COMMUNITY HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTONDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSWAC
Authorized Official - Phone:516-546-1771
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-0055
Mailing Address - Country:US
Mailing Address - Phone:516-546-1771
Mailing Address - Fax:516-623-5885
Practice Address - Street 1:950 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4223
Practice Address - Country:US
Practice Address - Phone:516-546-1771
Practice Address - Fax:516-623-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02772512Medicaid