Provider Demographics
NPI:1609920438
Name:FRANKLIN HAMILTON CHAPTER NYSARC
Entity Type:Organization
Organization Name:FRANKLIN HAMILTON CHAPTER NYSARC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SADIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-359-7518
Mailing Address - Street 1:12 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-1028
Mailing Address - Country:US
Mailing Address - Phone:518-359-3351
Mailing Address - Fax:518-359-7820
Practice Address - Street 1:12 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-1028
Practice Address - Country:US
Practice Address - Phone:518-359-3351
Practice Address - Fax:518-359-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
NY6774445320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00921022Medicaid