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General NPI Number Information
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NPI Number | 1790326320
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Entity Type | Organization
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Legal Business Name | ACCESS: SUPPORTS FOR LIVING INC.
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 16 UNION ST
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City | MIDDLETOWN
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State | NY
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Zip | 10940-4906
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Country | US
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Telephone | 845-692-4454
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Fax | 845-692-8887
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Provider Business Mailing Address
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Address Line | 15 FORTUNE RD W
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City | MIDDLETOWN
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State | NY
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Zip | 10941-1625
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Country | US
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Telephone | 845-692-4454
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Fax | 845-692-8887
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | RONALD COLAVITO
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Credential |
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Telephone | 845-692-4454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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