Provider Demographics
NPI:1992337224
Name:COUNCIL ON ADDICTION RECOVERY SERVICES, INC.
Entity type:Organization
Organization Name:COUNCIL ON ADDICTION RECOVERY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXC ADMIN ASST/COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:M'LISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SUGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:716-373-4303
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-0567
Mailing Address - Country:US
Mailing Address - Phone:716-373-4303
Mailing Address - Fax:716-373-4327
Practice Address - Street 1:1355 OLEAN-PORTVILLE ROAD
Practice Address - Street 2:
Practice Address - City:WESTONS MILLS
Practice Address - State:NY
Practice Address - Zip Code:14788-1476
Practice Address - Country:US
Practice Address - Phone:716-373-0021
Practice Address - Fax:716-373-1719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNCIL ON ADDICTION RECOVERY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06254773Medicaid