Provider Demographics
NPI:1649317371
Name:THRESHOLD CENTER FOR ALTERNATIVE YOUTH SERVICES,INC.
Entity type:Organization
Organization Name:THRESHOLD CENTER FOR ALTERNATIVE YOUTH SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-327-7200
Mailing Address - Street 1:57 CENTRAL PARK
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2303
Mailing Address - Country:US
Mailing Address - Phone:585-454-7530
Mailing Address - Fax:585-454-7138
Practice Address - Street 1:145 PARSELLS AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-5118
Practice Address - Country:US
Practice Address - Phone:585-454-7530
Practice Address - Fax:585-454-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2701224R261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00648540Medicaid