Healthcare Provider Details

I. General information

NPI: 1104218908
Provider Name (Legal Business Name): ACHIEVEMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 NEW LOUDON RD
LATHAM NY
12110-4031
US

IV. Provider business mailing address

623 NEW LOUDON RD
LATHAM NY
12110-4031
US

V. Phone/Fax

Practice location:
  • Phone: 518-782-1178
  • Fax:
Mailing address:
  • Phone: 518-782-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMI CALLISTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 518-782-1178