| NPI | 1588343115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EARL RAYMOND JEFFERSON Director Of Central Operations 518-402-4333 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2023-07-12 |