Basic Information
| Provider Information | |||||||||
| NPI: | 1619962404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SARATOGA CARE FAMILY HEALTH CENTERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128661009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185802022 | ||||||||
| FaxNumber: | 5185840466 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 LAWRENCE ST | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128661346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185847361 | ||||||||
| FaxNumber: | 5185847930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2005 | ||||||||
| LastUpdateDate: | 01/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5185802022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00697301 | 05 | NY | MEDICAID |