Healthcare Provider Details

I. General information

NPI: 1093875007
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF ORANGE, SULLIVAN & ULSTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MATTHEWS STREET
GOSHEN NY
10924
US

IV. Provider business mailing address

27 MATTHEWS STREET
GOSHEN NY
10924
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-5124
  • Fax: 845-294-1369
Mailing address:
  • Phone: 845-294-5124
  • Fax: 845-294-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number070111579
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON KELLY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 845-294-5124