Provider Demographics
NPI:1497850671
Name:ST. CATHERINE'S CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:ST. CATHERINE'S CENTER FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY EXEC DIR ADMI
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIEGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-453-6714
Mailing Address - Street 1:40 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1481
Mailing Address - Country:US
Mailing Address - Phone:518-453-6700
Mailing Address - Fax:518-453-6712
Practice Address - Street 1:30 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1410
Practice Address - Country:US
Practice Address - Phone:518-453-6710
Practice Address - Fax:518-453-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02923857Medicaid
NY00353177Medicaid
NY00778941Medicaid