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TULLY HILL NPI 1629135512


NPI Information

NPI: 1629135512
Provider Name: TULLY HILL
Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 33D2060407

Address:
5821 ROUTE 80
TULLY, NY
ZIP 13159
Phone: (315) 696-6114
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TULLY HILL is a substance abuse rehabilitation facility in Tully, NY. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. TULLY HILL NPI is 1629135512. The provider is registered as an organization entity type.

The provider's business location address is:

5821 ROUTE 80
TULLY, NY
ZIP 13159-116
Phone: (315) 696-6114
Fax: (315) 696-8509

The provider's authorized official is Stephanie L Vormwald .
The authorized official title is Controller and has the following contact phone number (315) 696-6114.

The CLIA number assigned to this NPI record is 33D2060407 - ancillary testing site in health care center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/2/2007 and was last updated on 4/22/2014.


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
1261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
2324500000XSubstance Abuse Rehabilitation FacilityYes

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
101805967MEDICAIDNEW 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: 5/5/2024

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