Provider Demographics
NPI:1952309866
Name:GREATER ADIRONDACK HOME AIDES
Entity type:Organization
Organization Name:GREATER ADIRONDACK HOME AIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-926-7070
Mailing Address - Street 1:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0678
Mailing Address - Country:US
Mailing Address - Phone:518-926-7070
Mailing Address - Fax:518-926-7074
Practice Address - Street 1:25 WILLOWBROOK RD STE 4
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3137
Practice Address - Country:US
Practice Address - Phone:518-926-7070
Practice Address - Fax:518-926-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0678L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00358076Medicaid