Provider Demographics
NPI:1528081734
Name:SUBURBAN ADULT SERVICES-INC.
Entity type:Organization
Organization Name:SUBURBAN ADULT SERVICES-INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANNUZIATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-805-1555
Mailing Address - Street 1:960 WEST MAPLE COURT
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9530
Mailing Address - Country:US
Mailing Address - Phone:716-805-1555
Mailing Address - Fax:716-805-1441
Practice Address - Street 1:960 WEST MAPLE COURT
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9530
Practice Address - Country:US
Practice Address - Phone:716-805-1555
Practice Address - Fax:716-805-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
11911AMedicare ID - Type Unspecified