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General NPI Number Information
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NPI Number | 1427696061
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Entity Type | Organization
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Legal Business Name | ELDERBERRY ICF
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 15 POEM PLACE
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City | MONTICELLO
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State | NY
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Zip | 12701
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Country | US
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Telephone | 845-707-8341
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 840
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City | HARRIS
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State | NY
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Zip | 12742-0840
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Country | US
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Telephone | 845-707-8135
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Fax |
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Authorized Official
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Title or Position | VP BUSINESS DEVELOPMENT
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Name | PHILIP JOSEPH MORACI
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Credential |
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Telephone | 845-707-8135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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