Provider Demographics
NPI:1366456329
Name:CONFIDENTIAL HELP FOR ALCOHOL AND DRUGS, INC.
Entity Type:Organization
Organization Name:CONFIDENTIAL HELP FOR ALCOHOL AND DRUGS, INC.
Other - Org Name:C.H.A.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARES
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:315-253-9786
Mailing Address - Street 1:75 GENESEE ST
Mailing Address - Street 2:STE 4
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3644
Mailing Address - Country:US
Mailing Address - Phone:315-253-9786
Mailing Address - Fax:315-253-7502
Practice Address - Street 1:75 GENESEE ST
Practice Address - Street 2:STE 4
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3644
Practice Address - Country:US
Practice Address - Phone:315-253-9786
Practice Address - Fax:315-253-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00949853Medicaid