Provider Demographics
NPI:1437101417
Name:THE ADDICTIONS CARE CENTER OF ALBANY, INC
Entity Type:Organization
Organization Name:THE ADDICTIONS CARE CENTER OF ALBANY, INC
Other - Org Name:ALBANY CITIZENS COUNCIL ON ALCOHOLISM AND OTHER CHEMICAL DEPENDENCIES,
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-465-5470
Mailing Address - Street 1:90 MCCARTY AVENUE
Mailing Address - Street 2:ADMINISTRATION-BLDG 1
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-1151
Mailing Address - Country:US
Mailing Address - Phone:518-465-5470
Mailing Address - Fax:518-427-0854
Practice Address - Street 1:1044 BROADWAY
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204
Practice Address - Country:US
Practice Address - Phone:518-434-2367
Practice Address - Fax:518-434-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040401001994OtherFIDELIS
NY142863OtherVALUEOPTIONS
NY341553OtherMVP
NY110056185001OtherCDPHP
NY01034239Medicaid
NY10056185OtherCDPHP / SPBHM
NY1056910OtherWELLCARE
NY341553OtherVALUE OPTIONS