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General NPI Number Information
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NPI Number | 1245199116
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Entity Type | Organization
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Legal Business Name | PHOENIX EARLY INTERVENTION LLC
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 418 BROADWAY STE N
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone | 518-241-6552
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Fax |
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Provider Business Mailing Address
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Address Line | 350 NORTHERN BLVD STE 324-1565
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City | ALBANY
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State | NY
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Zip | 12204-1000
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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 | CEO
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Name | MR. JESSE CASCO
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Credential |
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Telephone | 917-231-5776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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