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General NPI Number Information
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NPI Number | 1548262363
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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 | 08/11/2005
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Last Update Date | 10/02/2016
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Provider Practice Location Address
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Address Line | 334 W STATE ST
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City | ITHACA
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State | NY
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Zip | 14850-5432
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Country | US
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Telephone | 607-273-5500
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Fax | 607-273-1277
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Provider Business Mailing Address
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Address Line | 38 EAST MAIN STREET PO BOX 724
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City | TRUMANSBURG
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State | NY
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Zip | 14886
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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 OFFICERE
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Name | MS. SUSAN M 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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 070510837
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License Number State | NY
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