Provider Demographics
NPI:1538666052
Name:UPSTATE CEREBRAL PALSY, INC.
Entity Type:Organization
Organization Name:UPSTATE CEREBRAL PALSY, INC.
Other - Org Name:UPSTATE CEREBRAL PALSY, INC. WESTMORELAND ICF
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENO
Authorized Official - Middle Name:
Authorized Official - Last Name:DECONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-724-6907
Mailing Address - Street 1:125 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6305
Mailing Address - Country:US
Mailing Address - Phone:315-724-6907
Mailing Address - Fax:315-733-0791
Practice Address - Street 1:95 SEYMOUR LANE
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:NY
Practice Address - Zip Code:13490
Practice Address - Country:US
Practice Address - Phone:315-927-3480
Practice Address - Fax:315-927-3481
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPSTATE CEREBRAL PALSY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-11
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
62820440315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities