Provider Demographics
NPI:1205008794
Name:UNITED CEREBRAL PALSY OF ULSTER COUNTY INC.
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF ULSTER COUNTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-336-7235
Mailing Address - Street 1:PO BOX 1488
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-1488
Mailing Address - Country:US
Mailing Address - Phone:845-336-7235
Mailing Address - Fax:845-336-4726
Practice Address - Street 1:234 TUYTENBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5429
Practice Address - Country:US
Practice Address - Phone:845-336-7235
Practice Address - Fax:845-336-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01112252Medicaid