Provider Demographics
NPI:1407176571
Name:FULTON COUNTY ARC
Entity Type:Organization
Organization Name:FULTON COUNTY ARC
Other - Org Name:LEXINGTON CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-736-3825
Mailing Address - Street 1:465 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-1014
Mailing Address - Country:US
Mailing Address - Phone:518-736-3825
Mailing Address - Fax:
Practice Address - Street 1:465 N PERRY ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-1014
Practice Address - Country:US
Practice Address - Phone:518-736-3825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006168-1251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services