Provider Demographics
NPI:1932331667
Name:ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.
Entity Type:Organization
Organization Name:ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.
Other - Org Name:SMITH HOUSE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-963-4275
Mailing Address - Street 1:159 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1874
Mailing Address - Country:US
Mailing Address - Phone:518-561-3377
Mailing Address - Fax:518-563-7433
Practice Address - Street 1:159 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1874
Practice Address - Country:US
Practice Address - Phone:518-561-3377
Practice Address - Fax:518-563-7433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-13
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55965AMedicare PIN