Provider Demographics
NPI:1821205766
Name:UNITED CEREBRAL PALSY ASSOC OF PUTNAM & SOUTHERN DUTCHESS
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOC OF PUTNAM & SOUTHERN DUTCHESS
Other - Org Name:UCP NYS HIMES ICF
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-878-9078
Mailing Address - Street 1:40 JON BARRETT RD
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2164
Mailing Address - Country:US
Mailing Address - Phone:845-878-9078
Mailing Address - Fax:
Practice Address - Street 1:26 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-3936
Practice Address - Country:US
Practice Address - Phone:845-878-9078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01117257Medicaid