Healthcare Provider Details

I. General information

NPI: 1811361728
Provider Name (Legal Business Name): SAMARITAN DAYTOP VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 FORBELL ST
BROOKLYN NY
11208-3403
US

IV. Provider business mailing address

138-02 QUEENS BLVD
BRIARWOOD NY
11435
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-1990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MADRAY
Title or Position: VP OF HEALTH SERVICES & COMM. BASED
Credential:
Phone: 718-206-2000