Provider Demographics
NPI:1114131075
Name:COMMUNITY WORK AND INDEPENDENCE, INC.
Entity Type:Organization
Organization Name:COMMUNITY WORK AND INDEPENDENCE, INC.
Other - Org Name:FOOTHILLS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:518-745-8084
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:ACCOUNTING DEPARTMENT
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0303
Mailing Address - Country:US
Mailing Address - Phone:518-745-8084
Mailing Address - Fax:518-745-1413
Practice Address - Street 1:37 EVERTS AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12804-2040
Practice Address - Country:US
Practice Address - Phone:518-793-4700
Practice Address - Fax:518-743-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02249136261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55375AOtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER