Healthcare Provider Details

I. General information

NPI: 1396822839
Provider Name (Legal Business Name): SAMARITAN DAYTOP VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13020 89TH RD
RICHMOND HILL NY
11418-3301
US

IV. Provider business mailing address

13802 QUEENS BLVD
BRIARWOOD NY
11435-2642
US

V. Phone/Fax

Practice location:
  • Phone: 718-441-8913
  • Fax: 718-805-6041
Mailing address:
  • Phone: 718-206-2000
  • Fax: 718-206-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number16890
License Number StateNY

VIII. Authorized Official

Name: MR. CHARLES MADRAY
Title or Position: VICE PRESIDENT OF HEALTH & COMM
Credential:
Phone: 718-764-4249