Provider Demographics
NPI:1518923648
Name:AUGUST AICHHORN CENTER FOR ADOLESCENT RESIDENTIAL CARE, INC.
Entity Type:Organization
Organization Name:AUGUST AICHHORN CENTER FOR ADOLESCENT RESIDENTIAL CARE, INC.
Other - Org Name:RTF AUGUST AICHHORN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAWEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-873-9170
Mailing Address - Street 1:15 W 72ND ST
Mailing Address - Street 2:ROOM L-J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3402
Mailing Address - Country:US
Mailing Address - Phone:212-873-9170
Mailing Address - Fax:212-721-4106
Practice Address - Street 1:23 W 106TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3806
Practice Address - Country:US
Practice Address - Phone:212-316-9353
Practice Address - Fax:212-662-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01233738Medicaid