Provider Demographics
NPI:1437320694
Name:OTSEGO COUNTY CHAPTER, NYSARC, INC.
Entity Type:Organization
Organization Name:OTSEGO COUNTY CHAPTER, NYSARC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-433-8400
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:35 ACADEMY STREET
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-0490
Mailing Address - Country:US
Mailing Address - Phone:607-433-8409
Mailing Address - Fax:607-433-6744
Practice Address - Street 1:47 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1146
Practice Address - Country:US
Practice Address - Phone:607-432-7860
Practice Address - Fax:607-432-7864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NYSARC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00994885320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00994885Medicaid