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NPI Code Detail

MEDICARE: LASALLE SCHOOL

MEDICARE: LASALLE SCHOOL
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
13245S0500XChildren's Substance Abuse Rehabilitation Facility101110842NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861664617
Entity Type Code : Organization
Provider Name (Legal Business Name) : LASALLE SCHOOL
Provider Business Mailing Address
First Line : 391 WESTERN AVE
Second Line :
City : ALBANY
State : NY
Zip : 12203-1491
Country : US
Telephone Number : 518-242-4731
Fax Number : 518-242-4744
Provider Business Practice Location Address
First Line : 391 WESTERN AVE
Second Line :
City : ALBANY
State : NY
Zip : 12203-1491
Country : US
Telephone Number : 518-242-4731
Fax Number : 518-242-4744
Authorized Official
Title or Position : ASSOCIATE EXECUTIVE DIRECTOR
Name : MR. MARK R. LAHUT
Credential :
Telephone Number : 518-242-4731
Provider Enumeration Date : 04/01/2008
Last Update Date : 04/01/2008

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Directions to “LASALLE SCHOOL ” Practice Location

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