Provider Demographics
NPI:1912150046
Name:STORY PLACE PRESCHOOL
Entity Type:Organization
Organization Name:STORY PLACE PRESCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALTWERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:518-477-6072
Mailing Address - Street 1:2500 POND VW
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9750
Mailing Address - Country:US
Mailing Address - Phone:518-477-6072
Mailing Address - Fax:518-477-6074
Practice Address - Street 1:2500 POND VW
Practice Address - Street 2:SUITE 102A
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9750
Practice Address - Country:US
Practice Address - Phone:518-477-6072
Practice Address - Fax:518-477-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005266261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy