Healthcare Provider Details

I. General information

NPI: 1659565059
Provider Name (Legal Business Name): VANDERHEYDEN HALL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 COOPER HILL RD ROUTE 355
WYNANTSKILL NY
12198-2906
US

IV. Provider business mailing address

PO BOX 219 ROUTE 355
WYNANTSKILL NY
12198-0219
US

V. Phone/Fax

Practice location:
  • Phone: 518-283-6500
  • Fax: 518-283-3013
Mailing address:
  • Phone: 518-283-6500
  • Fax: 518-283-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberRID1911/VID00A02360B
License Number StateNY

VIII. Authorized Official

Name: MRS. LINDA B. MAPPES
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 518-283-6500