Provider Demographics
NPI:1811145352
Name:THE BETSY SIEGEL LITTLE HOUSE, INC.
Entity type:Organization
Organization Name:THE BETSY SIEGEL LITTLE HOUSE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-354-3581
Mailing Address - Street 1:64 NEW POMONA RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-1817
Mailing Address - Country:US
Mailing Address - Phone:845-354-3581
Mailing Address - Fax:
Practice Address - Street 1:64 NEW POMONA RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-1817
Practice Address - Country:US
Practice Address - Phone:845-354-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01305164Medicaid