Healthcare Provider Details

I. General information

NPI: 1295804763
Provider Name (Legal Business Name): ST CHRISTOPHERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 SOUTH BROADWAY
DOBBS FERRY NY
10522
US

IV. Provider business mailing address

71 SOUTH BROADWAY
DOBBS FERRY NY
10522
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-3030
  • Fax: 914-674-9829
Mailing address:
  • Phone: 914-693-3030
  • Fax: 914-674-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00327720
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: JOSEPH SEMEDEI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 914-693-3030