Provider Demographics
NPI:1700153822
Name:COLONIE YOUTH CENTER, INC.
Entity Type:Organization
Organization Name:COLONIE YOUTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:518-438-9596
Mailing Address - Street 1:21 AVIATION RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1141
Mailing Address - Country:US
Mailing Address - Phone:518-438-9596
Mailing Address - Fax:518-438-9598
Practice Address - Street 1:21 AVIATION RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1141
Practice Address - Country:US
Practice Address - Phone:518-438-9596
Practice Address - Fax:518-438-9598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health