Provider Demographics
NPI:1659565059
Name:VANDERHEYDEN HALL, INC.
Entity Type:Organization
Organization Name:VANDERHEYDEN HALL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAPPES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:518-283-6500
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:ROUTE 355
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-0219
Mailing Address - Country:US
Mailing Address - Phone:518-283-6500
Mailing Address - Fax:518-283-3013
Practice Address - Street 1:614 COOPER HILL RD
Practice Address - Street 2:ROUTE 355
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198-2906
Practice Address - Country:US
Practice Address - Phone:518-283-6500
Practice Address - Fax:518-283-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRID1911/VID00A02360B322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00353493Medicaid