Healthcare Provider Details

I. General information

NPI: 1124182035
Provider Name (Legal Business Name): PILGRIM PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
WEST BRENTWOOD NY
11717-1043
US

IV. Provider business mailing address

44 HOLLAND AVE
ALBANY NY
12229-0001
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNY

VIII. Authorized Official

Name: BETH GIARRUSSO
Title or Position: DIRECTOR, FINANCE
Credential:
Phone: 518-473-0795