Provider Demographics
NPI:1952309866
Name:GREATER ADIRONDACK HOME AIDES
Entity Type:Organization
Organization Name:GREATER ADIRONDACK HOME AIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-926-7000
Mailing Address - Street 1:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0678
Mailing Address - Country:US
Mailing Address - Phone:518-926-7070
Mailing Address - Fax:518-926-7074
Practice Address - Street 1:5 WARREN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4558
Practice Address - Country:US
Practice Address - Phone:518-926-7070
Practice Address - Fax:518-926-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0678L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00358076Medicaid