Mountain Lake Services

LBN: Essex County Chapter, Nysarc, Inc.
Mountain Lake Services is an health care organization with primary practice located at 10 St. Patrick'S Place , Port Henry NY 12974. The organization recently has 2 registered licenses in different health care specialties including Agencies / Early Intervention Provider Agency, Ambulatory Health Care Facilities / Developmental Disabilities. Agencies / Early Intervention Provider Agency is the primary health care specialty. Essex County Chapter, Nysarc, Inc. can be contacted via phone (518) 546-3051, or through Nephew, Martin Joseph via phone (518) 546-3381.

Contact Information

Primary practice address
10 St. Patrick'S Place Port Henry NY 12974
Phone: (518) 546-3051
Fax: (518) 546-3094
Website:
Map and Directions
Authorized official contact:
Name: Nephew, Martin Joseph
Phone: (518) 546-3381

Health care specialties

SpecialtyCodeLicense #State
Agencies / Early Intervention Provider Agency 252Y00000X 150901880216 New York
Ambulatory Health Care Facilities / Developmental Disabilities 261QD1600X New York

Profile Details

NPI number 1427134451
LBN Legal business name Essex County Chapter, Nysarc, Inc.
DBA Doing business as Mountain Lake Services
Authorized official Nephew, Martin Joseph
Entity Organization
Organization subpart 1 No
Enumeration date Oct 31st, 2006
Last updated Mar 23rd, 2016 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427134451 NPPES
New York Other 6763301 OPERATING CERTIFICATE #
New York MEDICAID 01276842 OPERATING CERTIFICATE #
New York Other 03 OPERATING CERTIFICATE #

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