CREDO COMMUNITY CENTER FOR TREATMENT OF ADDICTIONS INC NPI 1659389021

NPI Information

NPI: 1659389021
Provider Name: CREDO COMMUNITY CENTER FOR TREATMENT OF ADDICTIONS INC

Other Name: CREDO COMMUNITY CENTER FOR THE TREATMENT OF ADDICTIONS INC

Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

Address:
595 W MAIN ST
WATERTOWN, NY
ZIP 13601
Phone: (315) 788-1530
Get Directions

CREDO COMMUNITY CENTER FOR TREATMENT OF ADDICTIONS INC is a rehabilitation and substance use disorder clinic center in Watertown, NY. CREDO COMMUNITY CENTER FOR TREATMENT OF ADDICTIONS INC NPI is 1659389021. The provider is registered as an organization entity type.
The provider Other Name Is Credo Community Center For The Treatment Of Addictions Inc.

The provider's business location address is:

595 W MAIN ST
WATERTOWN, NY
ZIP 13601-335
Phone: (315) 788-1530
Fax: (315) 788-3794

The provider's authorized official is John Wilson .
The authorized official title is Executive Director and has the following contact phone number (315) 788-1530.

The enumeration date for this NPI number is 8/3/2006 and was last updated on 6/25/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	324500000X	Substance Abuse Rehabilitation Facility			NEW YORK	No
2	261QM2800X	Clinic/Center	Methadone			No
3	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	070310744	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	02921011	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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