Healthcare Provider Details

I. General information

NPI: 1215091152
Provider Name (Legal Business Name): DANFORTH ADULT CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DANFORTH ST
HOOSICK FALLS NY
12090-1223
US

IV. Provider business mailing address

23 COMPUTER DR E
ALBANY NY
12205-1276
US

V. Phone/Fax

Practice location:
  • Phone: 518-686-5167
  • Fax: 518-686-4428
Mailing address:
  • Phone: 518-459-0786
  • Fax: 518-459-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0815L001
License Number StateNY

VIII. Authorized Official

Name: MR. GLENN MAZULA
Title or Position: OWNER
Credential:
Phone: 518-459-0786