Healthcare Provider Details

I. General information

NPI: 1629438692
Provider Name (Legal Business Name): CATHOLIC CHARITIES COMMUNITY SERVICES OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HAMITON AVE
MONTICELLO NY
12701-1411
US

IV. Provider business mailing address

9 STARR AVE
MONTICELLO NY
12701-1411
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-8080
  • Fax:
Mailing address:
  • Phone: 845-794-0716
  • 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: DEBRA SULLIVAN
Title or Position: RESIDENT COUNSELOR
Credential:
Phone: 845-794-8080