Healthcare Provider Details

I. General information

NPI: 1124213277
Provider Name (Legal Business Name): ACCESS: SUPPORTS FOR LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FORTUNE RD W
MIDDLETOWN NY
10941-1625
US

IV. Provider business mailing address

15 FORTUNE RD W
MIDDLETOWN NY
10941-1625
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-4454
  • Fax: 845-692-8887
Mailing address:
  • Phone: 845-692-4454
  • Fax: 845-692-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY ANDERSON-WINCHELL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 845-692-4454