Basic Information
| Provider Information | |||||||||
| NPI: | 1841335197 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARDINAL MCCLOSKEY SCHOOL AND HOME FOR CHILDREN | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | CARDINAL MCCLOSKEY SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2 HOLLAND AVE | ||||||||
| Address2: | FINANCE DEPT. | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106033318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149978000 | ||||||||
| FaxNumber: | 9149972166 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 HOLLAND AVE | ||||||||
| Address2: | FINANCE DEPT. | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106033318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149978000 | ||||||||
| FaxNumber: | 9149972166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 10/20/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ACKER | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9149978000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | NY | N | Agencies | Voluntary or Charitable | 251S00000X | NY | N | Agencies | Community/Behavioral Health | 253J00000X | NY | Y | Agencies | Foster Care Agency |
ID Information
| ID | Type | State | Issuer | Description | 02923908 | 05 | NY | MEDICAID | 02557913 | 05 | NY | MEDICAID | 00327931 | 05 | NY | MEDICAID | 02391591 | 05 | NY | MEDICAID |