Healthcare Provider Details
I. General information
NPI: 1962491852
Provider Name (Legal Business Name): NYSARC, INC. BROOME-TIOGA COUNTY CHAPTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
125 CUTLER POND RD
BINGHAMTON NY
13905-1564
US
IV. Provider business mailing address
125 CUTLER POND RD
BINGHAMTON NY
13905-1564
US
V. Phone/Fax
- Phone: 607-723-8361
- Fax: 607-231-5310
- Phone: 607-723-8361
- Fax: 607-231-5310
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066441 |
| License Number State | NY |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066443 |
| License Number State | NY |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066440 |
| License Number State | NY |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066454 |
| License Number State | NY |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066442 |
| License Number State | NY |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066450 |
| License Number State | NY |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066461 |
| License Number State | NY |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066462 |
| License Number State | NY |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066444 |
| License Number State | NY |
| # 10 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 320600000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| License Number | 6066120 |
| License Number State | NY |
VIII. Authorized Official
Name:
MARY JO
THORN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 607-723-8361
