MEDICARE: THE SALVATION ARMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QA0600X	Adult Day Care Clinic/Center
2	251S00000X	Community/Behavioral Health Agency
3	251V00000X	Voluntary or Charitable Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205031598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SALVATION ARMY

Provider Business Mailing Address
First Line	:	200 TWIN OAKS DR
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13206
Country	:	US
Telephone Number	:	315-434-1300
Fax Number	:	845-620-7753

Provider Business Practice Location Address
First Line	:	749 S WARREN ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13202
Country	:	US
Telephone Number	:	315-479-5168
Fax Number	:	315-475-6307

Authorized Official
Title or Position	:	SECRETARY
Name	:	AYANA M. ROBERTSON
Credential	:
Telephone Number	:	845-620-7200

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	12/11/2025

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Directions to “THE SALVATION ARMY ” Practice Location

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