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General NPI Number Information
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NPI Number | 1215621586
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Entity Type | Organization
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Legal Business Name | UPSTATE PCA INSTITUTE
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 1216 GRAY AVE
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City | UTICA
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State | NY
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Zip | 13502-3959
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Country | US
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Telephone | 315-542-4209
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 GRAY AVE APT 2F
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City | UTICA
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State | NY
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Zip | 13502-3967
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Country | US
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Telephone | 315-864-0416
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Fax | 270-203-0587
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Authorized Official
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Title or Position | MD
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Name | SHANNON GREEN
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Credential | HHA,PCA
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Telephone | 315-864-0416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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