Provider Demographics
NPI:1992165567
Name:STACEY FREDERICK COMPASSIONATE CARE
Entity type:Organization
Organization Name:STACEY FREDERICK COMPASSIONATE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MISS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-797-9213
Mailing Address - Street 1:20 RED MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-9326
Mailing Address - Country:US
Mailing Address - Phone:845-797-9213
Mailing Address - Fax:
Practice Address - Street 1:20 RED MAPLE RD
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-9326
Practice Address - Country:US
Practice Address - Phone:845-797-9213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266189-1251E00000X, 251S00000X, 252Y00000X, 261QA1903X, 273R00000X, 305R00000X, 305S00000X, 311Z00000X, 320600000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No273R00000XHospital UnitsPsychiatric Unit
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child