Provider Demographics
NPI:1093841462
Name:HERKIMER COUNTY CHAPTER NYSARC, INC.
Entity Type:Organization
Organization Name:HERKIMER COUNTY CHAPTER NYSARC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-866-2920
Mailing Address - Street 1:350 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-2426
Mailing Address - Country:US
Mailing Address - Phone:315-866-2920
Mailing Address - Fax:315-866-8339
Practice Address - Street 1:350 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2426
Practice Address - Country:US
Practice Address - Phone:315-866-2920
Practice Address - Fax:315-866-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00657621Medicaid