Provider Demographics
NPI:1114380953
Name:RESCUE MISSION OF UTICA, INC.
Entity Type:Organization
Organization Name:RESCUE MISSION OF UTICA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-735-1645
Mailing Address - Street 1:212 RUTGER ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3618
Mailing Address - Country:US
Mailing Address - Phone:315-735-1645
Mailing Address - Fax:315-793-8211
Practice Address - Street 1:210 LANSING ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-2900
Practice Address - Country:US
Practice Address - Phone:315-735-1645
Practice Address - Fax:315-793-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160910155251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable