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General NPI Number Information
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NPI Number | 1518110618
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Entity Type | Organization
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Legal Business Name | UNITED CEREBRAL PALSY ASSOCIATION OF THE TRI-COUNTIES, INC.
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 133 AVIATION RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-8206
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Country | US
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Telephone | 518-798-0170
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Fax | 518-743-0227
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Provider Business Mailing Address
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Address Line | 133 AVIATION RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-8206
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Country | US
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Telephone | 518-798-0170
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Fax | 518-743-0227
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ARTHUR LARRIE GOUGE
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Credential |
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Telephone | 518-798-0170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | EI20070906
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License Number State | NY
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