| NPI | 1023381100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID HAROLD SHIPPEE President & CEO 518-591-4459 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: NY 0101205R) |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2018-12-18 |