Provider Demographics
NPI:1982820213
Name:MOHAWK OPPORTUNITIES, INC.
Entity Type:Organization
Organization Name:MOHAWK OPPORTUNITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-374-8424
Mailing Address - Street 1:201 NOTT TERRACE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12307
Mailing Address - Country:US
Mailing Address - Phone:518-374-8424
Mailing Address - Fax:518-374-8440
Practice Address - Street 1:201 NOTT TERRACE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12307
Practice Address - Country:US
Practice Address - Phone:518-374-8424
Practice Address - Fax:518-374-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7638470A261QM0801X
NY7638430320800000X
NY7638434320800000X
NY7638432320800000X
NY7638435320800000X
NY7638431320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02752752Medicaid
NY01304407Medicaid