UPSTATE CEREBRAL PALSY
Intermediate Care Facility, Mentally Retarded
Utica, New York
Provider NPI: 1184785172
Organization Information:Organization Name: UPSTATE CEREBRAL PALSY
Practice Location:
1235 TILDEN AVE UTICA, NY 13501 US
Tel: 315-798-9577 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
1235 TILDEN AVE UTICA, NY 13501 US
Tel: 315-798-9577 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 315P00000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mentally Retarded | NY | 02007629 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
02007629 | NY | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin