Provider Demographics
NPI:1275766032
Name:ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.
Entity Type:Organization
Organization Name:ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.
Other - Org Name:SMITH HOUSE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:518-963-4275
Mailing Address - Street 1:39 FARRELL RD
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-3904
Mailing Address - Country:US
Mailing Address - Phone:518-963-4275
Mailing Address - Fax:518-963-8862
Practice Address - Street 1:2885 ESSEX RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:NY
Practice Address - Zip Code:12936-2317
Practice Address - Country:US
Practice Address - Phone:518-963-8800
Practice Address - Fax:518-963-8802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-27
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55965AMedicare PIN