Provider Demographics
NPI:1104067024
Name:CATHOLIC CHARITIES AIDS SERVICES
Entity type:Organization
Organization Name:CATHOLIC CHARITIES AIDS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-449-3581
Mailing Address - Street 1:100 SLINGERLAND ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-1229
Mailing Address - Country:US
Mailing Address - Phone:518-449-3581
Mailing Address - Fax:518-426-3662
Practice Address - Street 1:100 SLINGERLAND ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1229
Practice Address - Country:US
Practice Address - Phone:518-449-3581
Practice Address - Fax:518-426-3662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF THE DIOCESE OF ALBANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-24
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01440326Medicaid