Healthcare Provider Details

I. General information

NPI: 1629172762
Provider Name (Legal Business Name): ST JOSEPHS REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 GLENWOOD DR
SARANAC LAKE NY
12983-2385
US

IV. Provider business mailing address

159 GLENWOOD DR
SARANAC LAKE NY
12983-2385
US

V. Phone/Fax

Practice location:
  • Phone: 518-891-3950
  • Fax: 518-891-6134
Mailing address:
  • Phone: 518-891-3950
  • Fax: 518-891-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIGGETTE SHAHEEN
Title or Position: NETWORK SENIOR DIRECTOR, REVENUE
Credential:
Phone: 518-891-3801