Healthcare Provider Details

I. General information

NPI: 1154691368
Provider Name (Legal Business Name): LEXINGTON CENTER FOR RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NORTH RD
POUGHKEEPSIE NY
12601-1328
US

IV. Provider business mailing address

2875 ROUTE 35 STE 6N1
KATONAH NY
10536-3181
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-2850
  • Fax: 845-486-2770
Mailing address:
  • Phone: 914-666-0191
  • Fax: 914-232-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number100911477
License Number StateNY

VIII. Authorized Official

Name: SUZANNE TISNE
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 914-666-0191