MEDICARE: ELMCREST CHILDRENS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568595338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELMCREST CHILDRENS CENTER

Provider Business Mailing Address
First Line	:	960 SALT SPRINGS RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13224-1639
Country	:	US
Telephone Number	:	315-446-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 LAFAYETTE RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13205-2921
Country	:	US
Telephone Number	:	315-492-9990
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOHN E HENLEY
Credential	:
Telephone Number	:	315-446-6250

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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