Provider Demographics
NPI:1902960610
Name:ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.
Entity Type:Organization
Organization Name:ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.
Other - Org Name:SMITH HOUSE HEALTH CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:518-963-4275
Mailing Address - Street 1:39 FARRELL RD
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-3904
Mailing Address - Country:US
Mailing Address - Phone:518-963-4275
Mailing Address - Fax:
Practice Address - Street 1:39 FARRELL RD
Practice Address - Street 2:
Practice Address - City:WILLSBORO
Practice Address - State:NY
Practice Address - Zip Code:12996-3904
Practice Address - Country:US
Practice Address - Phone:518-963-4275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1566200R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473478Medicaid
NYFQHCLA218Other340B ID
NY331970Medicare Oscar/Certification
NYFQHCLA218Other340B ID
NY00473478Medicaid