Healthcare Provider Details

I. General information

NPI: 1992165567
Provider Name (Legal Business Name): STACEY FREDERICK COMPASSIONATE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RED MAPLE RD
SAUGERTIES NY
12477-9326
US

IV. Provider business mailing address

20 RED MAPLE RD
SAUGERTIES NY
12477-9326
US

V. Phone/Fax

Practice location:
  • Phone: 845-797-9213
  • Fax:
Mailing address:
  • Phone: 845-797-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number266189-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number266189-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number266189-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number266189-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number266189-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number266189-1
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number266189-1
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number266189-1
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number266189-1
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number266189-1
License Number StateNY

VIII. Authorized Official

Name: MISS STACEY L FREDERICK
Title or Position: LPN
Credential:
Phone: 845-797-9213