Provider Demographics
NPI:1841304284
Name:NYSOMH/CAPITAL DISTRICT PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:NYSOMH/CAPITAL DISTRICT PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS NPP
Authorized Official - Phone:518-447-9611
Mailing Address - Street 1:175 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-2937
Mailing Address - Country:US
Mailing Address - Phone:518-436-4462
Mailing Address - Fax:518-436-4558
Practice Address - Street 1:175 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2937
Practice Address - Country:US
Practice Address - Phone:518-436-4462
Practice Address - Fax:518-436-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400371281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02341335Medicaid