Provider Demographics
NPI:1316970221
Name:CENTRAL NEW YORK SERVICES, INC.
Entity type:Organization
Organization Name:CENTRAL NEW YORK SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:315-478-2453
Mailing Address - Street 1:518 JAMES ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2238
Mailing Address - Country:US
Mailing Address - Phone:315-478-2453
Mailing Address - Fax:
Practice Address - Street 1:209 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2051
Practice Address - Country:US
Practice Address - Phone:315-492-1887
Practice Address - Fax:315-492-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8403031320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01304489Medicaid