Provider Demographics
NPI:1093855413
Name:FAMILY ADVOCACY CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY ADVOCACY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-797-8630
Mailing Address - Street 1:5639 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13502-1249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5639 WALKER RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:NY
Practice Address - Zip Code:13502-1249
Practice Address - Country:US
Practice Address - Phone:315-797-8630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01998801Medicaid
NY01522605Medicaid