ELDERBERRY ICF (NPI# 1427696061) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427696061 |
| Entity Type | Organization |
| Organization Name | ELDERBERRY ICF |
| Practice Address |
15 Poem Place Monticello NY 12701 |
| Mailing Address |
Po Box 840 Harris NY 12742-0840 |
| Practice Telephone | 8457078341 |
| Mailing Telephone | 8457078135 |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2019-12-13 |
| Authorized Official Name | PHILIP JOSEPH MORACI (VP BUSINESS DEVELOPMENT) |
| Authorized Official Telephone | 8457078135 |
| Is Organization Subpart | Y |
| Parent Organization Name | SDTC THE CENTER FOR DISCOVERY INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES | 74670475 | 01 |
| Other Name | Type Code |
|---|---|
| The Center for Discovery | Other Name - Individual/Organization |
| Street Address |
15 POEM PLACE |
| City | MONTICELLO |
| State | NY |
| Zip Code | 12701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346854023 | Julia Lynn Waldorf | Student in an Organized Health Care Education/Training Program | 141 Benmosche Road, Monticello, NY 12701 | 2020-09-01 |
| 1205450483 | Deanna Marie Prue | Speech-Language Pathologist | 141 Benmosche Rd, Monticello, NY 12701 | 2020-06-03 |
| 1114552262 | Lauren Madsen | Physical Therapist | 139 Benmosche Rd, Monticello, NY 12701 | 2020-03-10 |
| 1407301922 | Nicole M Casamassima | Speech-Language Pathologist | 640 Old Route 17, 641 Old Route 17, Monticello, NY 12701 | 2016-08-25 |
| 1144680018 | Deborah Jackson | Counselor | 17 Hamilton Avenue, Monticello, NY 12701 | 2016-03-04 |
| 1215354592 | Abdelhalim Zaghloul Nada | Physical Therapist | 427 Boardway, Suite #3, Mountain Physical Therapy, Monticello, NY 12701 | 2014-03-25 |
| 1720402795 | Christine Pham | Podiatrist | 427 Broadway Ste 2, Monticello, NY 12701 | 2014-02-12 |
| 1396095139 | Raquel Bottaro | Specialist | 504 South Woods Rd, Monticello, NY 12701 | 2012-09-19 |
| 1558620310 | Maria L Burns | Registered Nurse | 20 Crystal St, Monticello, NY 12701 | 2012-05-14 |
| 1871863522 | James P Sullivan | Physical Therapy Assistant | 507 Benmosche Rd, Monticello, NY 12701 | 2012-01-11 |
| Find all providers in zip 12701 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457547515 | Sdtc The Center for Discovery | Intermediate Care Facility, Mentally Retarded | 16 Unami Circle, Monticello, NY 12701 | 2007-09-21 |
| 1265628325 | Sdtc The Center for Discovery | Intermediate Care Facility, Mentally Retarded | 18 Unami Circle, Monticello, NY 12701 | 2007-09-21 |
| 1639365927 | Sdtc The Center for Discovery | Intermediate Care Facility, Mentally Retarded | 8 Unami Circle, Monticello, NY 12701 | 2007-09-20 |
| 1942496484 | Sdtc The Center for Discovery | Intermediate Care Facility, Mentally Retarded | 6 Unami Circle, Monticello, NY 12701 | 2007-09-19 |
| 1518085224 | The Residential Developers, Inc. | Intermediate Care Facility, Mentally Retarded | 1009 S Irving St, Monticello, IL 61856-1821 | 2007-03-27 |
| 1275690026 | Sdtc The Center for Discovery | Intermediate Care Facility, Mentally Retarded | 31 Holmes Rd, Monticello, NY 12701 | 2007-01-02 |
| 1649337585 | Sdtc The Center for Discovery | Intermediate Care Facility, Mentally Retarded | 60 Holmes Rd, Monticello, NY 12701 | 2007-01-02 |
| 1356408108 | Sdtc The Center for Discovery | Intermediate Care Facility, Mentally Retarded | 284 Old Rte 17, Monticello, NY 12701 | 2007-01-02 |
| 1174680938 | Sdtc The Center for Discovery | Intermediate Care Facility, Mentally Retarded | 284 Old Route 17, Monticello, NY 12701 | 2007-01-02 |
| 1407922065 | Sdtc The Center for Discovery | Intermediate Care Facility, Mentally Retarded | 175 Holmes Rd, Monticello, NY 12701 | 2006-11-27 |
| Find all providers in MONTICELLO | ||||
| City | MONTICELLO |
| Zip Code | 12701 |
Please comment or provide details below to improve the information on ELDERBERRY ICF.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.