Provider Demographics
NPI:1821562042
Name:ACADEMY HOUSE FOR ADULTS
Entity Type:Organization
Organization Name:ACADEMY HOUSE FOR ADULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-292-8343
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-0451
Mailing Address - Country:US
Mailing Address - Phone:845-292-8343
Mailing Address - Fax:
Practice Address - Street 1:15 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1794
Practice Address - Country:US
Practice Address - Phone:845-292-8343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility