Provider Demographics
NPI:1699162404
Name:ST. PETER'S ADDICTION AND RECOVERY CENTER
Entity type:Organization
Organization Name:ST. PETER'S ADDICTION AND RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OF SPARC OUTPATIENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-452-6700
Mailing Address - Street 1:845 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1514
Mailing Address - Country:US
Mailing Address - Phone:518-482-2455
Mailing Address - Fax:
Practice Address - Street 1:845 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1514
Practice Address - Country:US
Practice Address - Phone:518-482-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. PETER'S HEALTH PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139696387305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY139696387OtherNPI