Provider Demographics
NPI:1528403102
Name:IRECTORHUDSON MOHAWK RECOVERY CENTER
Entity Type:Organization
Organization Name:IRECTORHUDSON MOHAWK RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDON
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:518-272-3918
Mailing Address - Street 1:1724 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3320
Mailing Address - Country:US
Mailing Address - Phone:518-272-3918
Mailing Address - Fax:518-272-6391
Practice Address - Street 1:1724 5TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3320
Practice Address - Country:US
Practice Address - Phone:518-272-3918
Practice Address - Fax:518-272-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130510570251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health