Provider Demographics
NPI:1629243407
Name:ST. ANNE INSTITUTE
Entity Type:Organization
Organization Name:ST. ANNE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAKECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-437-6510
Mailing Address - Street 1:160 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1821
Mailing Address - Country:US
Mailing Address - Phone:518-437-6516
Mailing Address - Fax:518-437-6531
Practice Address - Street 1:160 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1821
Practice Address - Country:US
Practice Address - Phone:518-437-6516
Practice Address - Fax:518-437-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRID1B30/VID00A02053322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00353535Medicaid