Healthcare Provider Details

I. General information

NPI: 1093731069
Provider Name (Legal Business Name): ST.CHRISTOPHER'S INN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 FRANCISCAN WAY
GARRISON NY
10524-0150
US

IV. Provider business mailing address

PO BOX 150 RT 9 GRAYMOOR
GARRISON NY
10524-0150
US

V. Phone/Fax

Practice location:
  • Phone: 845-335-1000
  • Fax: 845-335-1017
Mailing address:
  • Phone: 845-335-1000
  • Fax: 845-335-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3953200R
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number02125430
License Number StateNY

VIII. Authorized Official

Name: MARK CAMPIONE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 845-335-1006