Provider Demographics
NPI:1154493013
Name:SDTC THE CENTER FOR DISCOVERY
Entity Type:Organization
Organization Name:SDTC THE CENTER FOR DISCOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-794-1400
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742-0840
Mailing Address - Country:US
Mailing Address - Phone:845-794-1400
Mailing Address - Fax:
Practice Address - Street 1:96 WAWANDA AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1318
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7467441OtherOPERATING CERTIFICATE
NY01008768Medicaid