Provider Demographics
NPI:1518182849
Name:ULSTER-GREENE ARC CHAPER OF NYSARC INC.
Entity Type:Organization
Organization Name:ULSTER-GREENE ARC CHAPER OF NYSARC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-331-2500
Mailing Address - Street 1:471 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2138
Mailing Address - Country:US
Mailing Address - Phone:845-331-4300
Mailing Address - Fax:845-331-4931
Practice Address - Street 1:1113 FLATBUSH ROAD
Practice Address - Street 2:BLDG. 1
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2138
Practice Address - Country:US
Practice Address - Phone:845-331-4300
Practice Address - Fax:845-331-4931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6177433315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid