Provider Demographics
NPI:1144476185
Name:CATHOLIC CHARITIES OF FULTON & MONTGOMERY COUNITES
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF FULTON & MONTGOMERY COUNITES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARI
Authorized Official - Middle Name:C
Authorized Official - Last Name:ACKERKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-762-8313
Mailing Address - Street 1:4 NICHOLAS ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-1223
Mailing Address - Country:US
Mailing Address - Phone:518-762-8313
Mailing Address - Fax:518-762-4092
Practice Address - Street 1:4 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-1223
Practice Address - Country:US
Practice Address - Phone:518-762-8313
Practice Address - Fax:518-762-4092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF ALBANY DIOCESE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01304636Medicaid