Provider Demographics
NPI:1225443211
Name:COUNCIL ON ADDICTION RECOVERY SERVICES INC
Entity Type:Organization
Organization Name:COUNCIL ON ADDICTION RECOVERY SERVICES INC
Other - Org Name:HAWTHORN HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
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:14760-3646
Mailing Address - Country:US
Mailing Address - Phone:716-373-4303
Mailing Address - Fax:716-373-4327
Practice Address - Street 1:1351 OLEAN - PORTVILLE RD
Practice Address - Street 2:
Practice Address - City:WESTONS MILLS
Practice Address - State:NY
Practice Address - Zip Code:14788
Practice Address - Country:US
Practice Address - Phone:716-373-0057
Practice Address - Fax:716-373-7910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNCIL ON ADDICTION RECOVERY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-27
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160310173324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00933817Medicaid
NY000000816000OtherBLUE CROSS
NY170809255OtherDUNS AND BRADSTREET
38160OtherOASAS
NY030770OtherNYS CHARITIES REGISTRATION