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General NPI Number Information
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NPI Number | 1932568755
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Entity Type | Organization
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Legal Business Name | WILLIAM GEORGE AGENCY
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 380 FREEVILLE RD
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City | FREEVILLE
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State | NY
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Zip | 13068
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Country | US
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Telephone | 607-844-6236
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Fax |
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Provider Business Mailing Address
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Address Line | 380 FREEVILLE RD
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City | FREEVILLE
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State | NY
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Zip | 13068
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COTTAGE DIRECTOR
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Name | MELANIE AUERBACH
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Credential |
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Telephone | 607-844-6236
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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 | 095210-1
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License Number State | NY
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