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General NPI Number Information
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NPI Number | 1780882373
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Entity Type | Organization
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Legal Business Name | MHA IN ULSTER COUNTY, INC.
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 221 TUYTENBRIDGE RD
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City | LAKE KATRINE
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State | NY
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Zip | 12449-5417
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Country | US
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Telephone | 845-336-4747
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Fax | 845-336-0192
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Provider Business Mailing Address
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Address Line | PO BOX 2304
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City | KINGSTON
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State | NY
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Zip | 12402-2304
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Country | US
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Telephone | 845-336-4747
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Fax | 845-336-0192
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Authorized Official
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Title or Position | CEO
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Name | MS. ELLEN L PENDEGAR
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Credential |
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Telephone | 845-336-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | NY
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