MEDICARE: ANDERSON CENTER FOR AUTISM

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	7118440	NY

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	:	1750438586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON CENTER FOR AUTISM

Provider Business Mailing Address
First Line	:	PO BOX 367
Second Line	:
City	:	STAATSBURG
State	:	NY
Zip	:	12580-0367
Country	:	US
Telephone Number	:	845-889-4034
Fax Number	:	845-889-4623

Provider Business Practice Location Address
First Line	:	4885 ROUTE 9
Second Line	:
City	:	STAATSBURG
State	:	NY
Zip	:	12580
Country	:	US
Telephone Number	:	845-889-4034
Fax Number	:	845-889-4623

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. TINA CHIRICO
Credential	:
Telephone Number	:	845-889-4034

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/22/2020

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