Provider Demographics
NPI:1457664997
Name:MOHAWK VALLEY PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:MOHAWK VALLEY PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:315-738-3800
Mailing Address - Street 1:1400 NOYES ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3854
Mailing Address - Country:US
Mailing Address - Phone:315-738-4440
Mailing Address - Fax:315-738-4410
Practice Address - Street 1:1400 NOYES ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3854
Practice Address - Country:US
Practice Address - Phone:315-738-4440
Practice Address - Fax:315-738-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208630-1283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578620795Medicaid