Provider Demographics
NPI:1215091152
Name:DANFORTH ADULT CARE CENTER
Entity type:Organization
Organization Name:DANFORTH ADULT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-459-0786
Mailing Address - Street 1:23 COMPUTER DR E
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1276
Mailing Address - Country:US
Mailing Address - Phone:518-459-0786
Mailing Address - Fax:518-459-0775
Practice Address - Street 1:19 DANFORTH ST
Practice Address - Street 2:
Practice Address - City:HOOSICK FALLS
Practice Address - State:NY
Practice Address - Zip Code:12090-1223
Practice Address - Country:US
Practice Address - Phone:518-686-5167
Practice Address - Fax:518-686-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0815L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01437278Medicaid