Provider Demographics
NPI:1316088982
Name:BERKSHIRE FARM CENTER & SERVICES FOR YOUTH
Entity type:Organization
Organization Name:BERKSHIRE FARM CENTER & SERVICES FOR YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:COX
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:518-781-4567
Mailing Address - Street 1:13640 STATE ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:NY
Mailing Address - Zip Code:12029-3504
Mailing Address - Country:US
Mailing Address - Phone:518-781-4567
Mailing Address - Fax:518-781-4566
Practice Address - Street 1:25 FRANKLIN ST STE 1059
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-1009
Practice Address - Country:US
Practice Address - Phone:585-454-1620
Practice Address - Fax:585-454-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02513115Medicaid
NY02825845Medicaid