Provider Demographics
NPI:1144395054
Name:COUNCIL ON ADDICTION RECOVERY SERVICES, INC.
Entity Type:Organization
Organization Name:COUNCIL ON ADDICTION RECOVERY SERVICES, INC.
Other - Org Name:CATTARAUGUS COUNTY COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:PRUTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPP, MA
Authorized Official - Phone:716-373-4303
Mailing Address - Street 1:201 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-0567
Mailing Address - Country:US
Mailing Address - Phone:716-373-4303
Mailing Address - Fax:716-373-4327
Practice Address - Street 1:201 S UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-0567
Practice Address - Country:US
Practice Address - Phone:716-373-4303
Practice Address - Fax:716-373-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070910702251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY38160OtherOASAS
NY00933817Medicaid