Healthcare Provider Details

I. General information

NPI: 1437238706
Provider Name (Legal Business Name): COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF SULLIVAN CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HAMILTON AVE
MONTICELLO NY
12701-1319
US

IV. Provider business mailing address

11 HAMILTON AVE
MONTICELLO NY
12701-1319
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-8080
  • Fax: 845-794-8343
Mailing address:
  • Phone: 845-794-8080
  • Fax: 845-791-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. IZETTA BRIGGS-BOLLING
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 845-794-8080