Provider Demographics
NPI:1720493802
Name:ALLEGANY COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE, INC.
Entity Type:Organization
Organization Name:ALLEGANY COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-593-1920
Mailing Address - Street 1:3084 TRAPPING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9445
Mailing Address - Country:US
Mailing Address - Phone:585-593-1920
Mailing Address - Fax:585-593-7697
Practice Address - Street 1:3084 TRAPPING BROOK RD
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9445
Practice Address - Country:US
Practice Address - Phone:585-593-1920
Practice Address - Fax:585-593-7697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151110170324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility