Provider Demographics
NPI:1821170291
Name:RC WARD ADDICTION TREATMENT CENTER
Entity Type:Organization
Organization Name:RC WARD ADDICTION TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC COMMISIONER DIV OF FINANCIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-457-5312
Mailing Address - Street 1:117 SEWARD AVENUE
Mailing Address - Street 2:BUILDING 92 SUITE 12 16
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:845-341-2500
Mailing Address - Fax:845-341-2570
Practice Address - Street 1:117 SEWARD AVENUE
Practice Address - Street 2:BUILDING 92 SUITE 12 16
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-341-2500
Practice Address - Fax:845-341-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01438095Medicaid