Provider Demographics
NPI:1861664617
Name:LASALLE SCHOOL
Entity Type:Organization
Organization Name:LASALLE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAHUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-242-4731
Mailing Address - Street 1:391 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1491
Mailing Address - Country:US
Mailing Address - Phone:518-242-4731
Mailing Address - Fax:518-242-4744
Practice Address - Street 1:391 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1491
Practice Address - Country:US
Practice Address - Phone:518-242-4731
Practice Address - Fax:518-242-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1011108423245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01439192Medicaid