Provider Demographics
NPI:1053850560
Name:ARISE CHILD AND FAMILY SERVICE INC
Entity Type:Organization
Organization Name:ARISE CHILD AND FAMILY SERVICE INC
Other - Org Name:ARISE OSWEGO CDPAP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-671-5119
Mailing Address - Street 1:635 JAMES STREET
Mailing Address - Street 2:ATTN: BUSINESS OFFICE
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2226
Mailing Address - Country:US
Mailing Address - Phone:315-671-2959
Mailing Address - Fax:315-422-0948
Practice Address - Street 1:635 JAMES STREET
Practice Address - Street 2:ATTN: BUSINESS OFFICE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2226
Practice Address - Country:US
Practice Address - Phone:315-671-2959
Practice Address - Fax:315-422-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01733917Medicaid
NY01733917Medicaid