Provider Demographics
NPI:1891896767
Name:CAN/AM YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:CAN/AM YOUTH SERVICES, INC.
Other - Org Name:ROSE HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SIENKIEWYCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-764-9700
Mailing Address - Street 1:100 COUNTY ROUTE 43
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662
Mailing Address - Country:US
Mailing Address - Phone:315-764-9700
Mailing Address - Fax:315-764-0005
Practice Address - Street 1:100 COUNTY ROUTE 43
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-4104
Practice Address - Country:US
Practice Address - Phone:315-764-9700
Practice Address - Fax:315-764-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01178385Medicaid