| NPI | 1992165567 |
|---|---|
| Doing Business As | STACEY FREDERICK |
| Entity Type | Organization |
| Authorized Contact | STACEY L FREDERICK Lpn 845-797-9213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health (Licence: NY 266189-1) |
| Additional Taxonomies | 251S00000X (Licence: NY 266189-1) |
| 252Y00000X Early Intervention Provider Agency (Licence: NY 266189-1) | |
| 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NY 266189-1) | |
| 273R00000X Psychiatric Unit (Licence: NY 266189-1) | |
| 305R00000X Preferred Provider Organization (Licence: NY 266189-1) | |
| 305S00000X Point of Service (Licence: NY 266189-1) | |
| 311Z00000X Custodial Care Facility (Licence: NY 266189-1) | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NY 266189-1) | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: NY 266189-1) | |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2016-02-25 |