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General NPI Number Information
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NPI Number | 1023226651
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Entity Type | Organization
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Legal Business Name | FULTON FREINDSHIP HOUSE, INC.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 462 N PERRY ST
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City | JOHNSTOWN
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State | NY
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Zip | 12095-1011
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Country | US
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Telephone | 518-762-2294
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Fax | 518-762-8947
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Provider Business Mailing Address
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Address Line | PO BOX 292
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-0003
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Country | US
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Telephone | 518-725-1512
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Fax | 518-725-2769
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. THOMAS RYAN
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Credential |
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Telephone | 518-725-1512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 01305068
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License Number State | NY
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