CREDO COMMUNITY CENTER FOR TREATMENT OF ADDICTIONS INC (NPI# 1659389021) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659389021 |
| Entity Type | Organization |
| Organization Name | CREDO COMMUNITY CENTER FOR TREATMENT OF ADDICTIONS INC |
| Other Organization Name | CREDO COMMUNITY CENTER FOR THE TREATMENT OF ADDICTIONS INC |
| Practice Address |
595 W Main St Watertown NY 13601-1335 |
| Practice Telephone | 3157881530 |
| Practice Fax Number | 3157883794 |
| Mailing Telephone | 3157881530 |
| Mailing Fax Number | 3157883794 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-06-25 |
| Authorized Official Name | JOHN WILSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3157881530 |
| Authorized Official Credential | BA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | NY | Residential Treatment Facilities | |
| N | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
Ambulatory Health Care Facilities | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
070310744 | NY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02921011 | 05 |
| Other Name | Type Code |
|---|---|
| Credo Community Center for the Treatment of Addictions Inc | Other Name - Individual/Organization |
| Street Address |
595 W MAIN ST |
| City | WATERTOWN |
| State | NY |
| Zip Code | 13601-1335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891330544 | Ashley Shaun Peppers | Social Worker | 595 W Main St, Watertown, NY 13601-1335 | 2019-11-16 |
| 1578928339 | Melinda Gabriel | Marriage & Family Therapist | 595 W Main St, Watertown, NY 13601-1335 | 2015-12-22 |
| 1902204464 | Elise Labatore | Counselor | 595 W Main St, Watertown, NY 13601-1335 | 2014-12-16 |
| 1760630073 | Credo Community Center for The Treatment of Addictions | Community/Behavioral Health | 595 W Main St, Watertown, NY 13601 | 2008-08-29 |
| 1609023167 | Patricia Fralick | Counselor | 595 W Main St, Watertown, NY 13601-1335 | 2008-08-26 |
| 1013164565 | Kim Downey | Counselor | 595 W Main St, Watertown, NY 13601-1335 | 2008-08-26 |
| 1699922146 | Chris Mcdonald | Counselor | 595 W Main St, Watertown, NY 13601-1335 | 2008-08-26 |
| 1851548325 | Joanne Nugent | Counselor | 595 W Main St, Watertown, NY 13601-1335 | 2008-08-26 |
| 1326295809 | Caryn White | Social Worker | 595 W Main St, Watertown, NY 13601-1335 | 2008-08-26 |
| 1275780728 | Randy Gardner | Counselor | 595 W Main St, Watertown, NY 13601-1335 | 2008-08-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801414156 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 122 Court Street, Empsall Bldg, Room 212, Watertown, NY 13601 | 2020-07-13 |
| 1083231377 | Katherine Anne Cahill | Counselor | 22679 Duffy Road, Watertown, NY 13601 | 2020-07-02 |
| 1851855431 | Hanna Kearney | Physical Therapist | 20053 Summit View Blvd Ste 2, Watertown, NY 13601 | 2019-01-28 |
| 1578039905 | North Country Counseling Services LLC | Counselor | 210 Court St. Suite 4, Watertown, NY 13601 | 2018-10-24 |
| 1073004388 | Megan Anna O'brien | Counselor | 221 S Rutland Street, Watertown, NY 13601 | 2018-05-22 |
| 1558860536 | Kimberly Lynne Amelio | Specialist | 24850 Hinds Rd, Watertown, NY 13601 | 2018-02-06 |
| 1952840050 | Alberto Gonzalez | Social Worker | 211 Jb Wise Plaza, Watertown, NY 13601 | 2017-02-22 |
| 1073967386 | Amanda Pisarski | Licensed Practical Nurse | 26713 Nys Rte 12, Watertown, NY 13601 | 2016-04-22 |
| 1396137709 | Daniel Ernest Morgan | Neuromusculoskeletal Medicine & OMM | 21101 Ny-12f, Building 2, Suite 7, Watertown, NY 13601 | 2015-02-21 |
| 1568868131 | Megan E. Zamora | Dental Hygienist | 14652-b Cedar Way, Watertown, NY 13601 | 2014-11-10 |
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| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| 1588066716 | Care Counseling Center, LLC | Clinic/Center | 214 W 116th St, New York, NY 10026-2494 | 2014-09-18 |
| 1831507573 | Nathaniel Chambers | Clinic/Center | 801 Saint Anns Ave, Bronx, NY 10456-7648 | 2014-07-25 |
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| 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.