Provider Demographics
NPI:1417457789
Name:LIFEPLAN CCO NY, LLC
Entity Type:Organization
Organization Name:LIFEPLAN CCO NY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAFCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-944-2100
Mailing Address - Street 1:22 CORPORATE WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2374
Mailing Address - Country:US
Mailing Address - Phone:518-944-2100
Mailing Address - Fax:
Practice Address - Street 1:1020 MARY ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1930
Practice Address - Country:US
Practice Address - Phone:315-724-6907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty