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General NPI Number Information
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NPI Number | 1497206221
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Entity Type | Organization
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Legal Business Name | ITHACA ALPHA HOUSE CENTER, INC.
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 6621 NYS ROUTE 227
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City | TRUMANSBURG
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State | NY
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Zip | 14886-0724
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Country | US
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Telephone | 607-387-5535
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Fax | 607-387-5526
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Provider Business Mailing Address
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Address Line | PO BOX 724 38 E MAIN ST.
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City | TRUMANSBURG
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State | NY
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Zip | 14886-0724
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Country | US
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Telephone | 607-387-5535
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Fax | 607-387-5526
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | SUSAN OAKS
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Credential |
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Telephone | 607-387-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 171212037
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License Number State | NY
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