MEDICARE: VANDERHEYDEN HALL, INC.

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	R8676430	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	:	1942495304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDERHEYDEN HALL, INC.

Provider Business Mailing Address
First Line	:	614 COOPER HILL RD
Second Line	:	ROUTE 355
City	:	WYNANTSKILL
State	:	NY
Zip	:	12198-2906
Country	:	US
Telephone Number	:	518-283-6500
Fax Number	:	518-283-3013

Provider Business Practice Location Address
First Line	:	614 COOPER HILL RD
Second Line	:	ROUTE 355
City	:	WYNANTSKILL
State	:	NY
Zip	:	12198-2906
Country	:	US
Telephone Number	:	518-283-6500
Fax Number	:	518-283-3013

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LINDA B MAPPES
Credential	:	MSW
Telephone Number	:	518-283-6500

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

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