MEDICARE: CAZENOVIA RECOVERY SYSTEMS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	161211952	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251112283	OTHER	NY	NY OASAS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417322686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAZENOVIA RECOVERY SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	2495 MAIN ST STE 417
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-2152
Country	:	US
Telephone Number	:	716-852-4331
Fax Number	:	716-852-4533

Provider Business Practice Location Address
First Line	:	7397 LAKE RD
Second Line	:
City	:	APPLETON
State	:	NY
Zip	:	14008-9612
Country	:	US
Telephone Number	:	716-795-3719
Fax Number	:	716-795-9458

Authorized Official
Title or Position	:	CEO
Name	:	LINDSAY HERNDON
Credential	:
Telephone Number	:	716-314-5903

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	05/23/2023

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