Provider Demographics
NPI:1770837460
Name:COMMUNITY, WORK, AND INDEPENDENCE, INC.
Entity Type:Organization
Organization Name:COMMUNITY, WORK, AND INDEPENDENCE, INC.
Other - Org Name:COMMUNITY WORKSHOP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-793-4700
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0303
Mailing Address - Country:US
Mailing Address - Phone:518-793-4700
Mailing Address - Fax:518-745-1413
Practice Address - Street 1:37 EVERTS AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12804-2040
Practice Address - Country:US
Practice Address - Phone:518-793-4700
Practice Address - Fax:518-745-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793017Medicaid