Healthcare Provider Details

I. General information

NPI: 1760543672
Provider Name (Legal Business Name): 820 RIVER STREET INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 DUANE AVE
SCHENECTADY NY
12304-2627
US

IV. Provider business mailing address

428 DUANE AVE
SCHENECTADY NY
12304-2627
US

V. Phone/Fax

Practice location:
  • Phone: 518-377-2448
  • Fax: 518-377-4257
Mailing address:
  • Phone: 518-377-2448
  • Fax: 518-377-4357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER YOUNG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: C.E.O.
Phone: 518-377-2448