Provider Demographics
NPI:1881003192
Name:CAZENOVIA RECOVERY SYSTEMS, INC.
Entity Type:Organization
Organization Name:CAZENOVIA RECOVERY SYSTEMS, INC.
Other - Org Name:CAZENOVIA MANOR
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-314-5903
Mailing Address - Street 1:2495 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2152
Mailing Address - Country:US
Mailing Address - Phone:716-822-8932
Mailing Address - Fax:716-828-0804
Practice Address - Street 1:486 N LEGION DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2341
Practice Address - Country:US
Practice Address - Phone:716-822-8932
Practice Address - Fax:716-828-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04591122Medicaid
NY260112050OtherNY OASAS
NY03A2292OtherNYS DOH NUMBER