Healthcare Provider Details

I. General information

NPI: 1245309434
Provider Name (Legal Business Name): NYSARC INC FULTON COUNTY CHAPTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N. PERRY ST.
JOHNSTOWN NY
12095
US

IV. Provider business mailing address

127 E STATE ST.
GLOVERSVILLE NY
12078
US

V. Phone/Fax

Practice location:
  • Phone: 518-762-0024
  • Fax: 518-736-3916
Mailing address:
  • Phone: 518-773-7931
  • Fax: 518-725-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN T KUZNIA
Title or Position: CFO
Credential:
Phone: 518-773-7931