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General NPI Number Information
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NPI Number | 1104442839
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Entity Type | Organization
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Legal Business Name | ICC MANAGEMENT & CONSULTING, INC
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 11 S UNION ST
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City | CAMBRIDGE
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State | NY
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Zip | 12816-1008
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Country | US
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Telephone | 518-677-3711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1355
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City | ALBANY
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State | NY
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Zip | 12201-1355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE DIRECTOR
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Name | ALICIA PEEK
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Credential |
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Telephone | 518-727-3802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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