Healthcare Provider Details

I. General information

NPI: 1891896767
Provider Name (Legal Business Name): CAN/AM YOUTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COUNTY ROUTE 43
MASSENA NY
13662-4104
US

IV. Provider business mailing address

100 COUNTY ROUTE 43
MASSENA NY
13662
US

V. Phone/Fax

Practice location:
  • Phone: 315-764-9700
  • Fax: 315-764-0005
Mailing address:
  • Phone: 315-764-9700
  • Fax: 315-764-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. HEATHER LEE SIENKIEWYCZ
Title or Position: BILLING
Credential:
Phone: 315-764-9700