=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053420919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEAFIELD CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 04/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 SEAFIELD LN
-----------------------------------------------------
City | WESTHAMPTON BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11978-2714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-288-1122
-----------------------------------------------------
Fax | 631-288-1638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 SEAFIELD LN
-----------------------------------------------------
City | WESTHAMPTON BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11978-2714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-288-1122
-----------------------------------------------------
Fax | 631-288-1638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MR. JOHN C HALEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-288-1122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------