Provider Demographics
NPI:1417322686
Name:CAZENOVIA RECOVERY SYSTEMS, INC.
Entity Type:Organization
Organization Name:CAZENOVIA RECOVERY SYSTEMS, INC.
Other - Org Name:SOMERSET HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-314-5903
Mailing Address - Street 1:2495 MAIN ST STE 417
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2152
Mailing Address - Country:US
Mailing Address - Phone:716-852-4331
Mailing Address - Fax:716-852-4533
Practice Address - Street 1:7397 LAKE RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:NY
Practice Address - Zip Code:14008-9612
Practice Address - Country:US
Practice Address - Phone:716-795-3719
Practice Address - Fax:716-795-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161211952324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY251112283OtherNY OASAS
NY07117935Medicaid