Healthcare Provider Details

I. General information

NPI: 1023585668
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF ORANGE, SULLIVAN & ULSTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 BROADWAY
MONTICELLO NY
12701-1157
US

IV. Provider business mailing address

396 BROADWAY
MONTICELLO NY
12701-1157
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-8080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: LAURIE MUOLLO
Title or Position: DIRECTOR OF INFORMATION SYSTEMS/COR
Credential:
Phone: 845-794-8080