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General NPI Number Information
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NPI Number | 1063589166
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Entity Type | Organization
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Legal Business Name | CATHOLIC GUARDIAN SOCIETY & HOME BUREAU
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 235 E MONTAUK HWY
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-4127
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Country | US
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Telephone | 631-728-5657
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Fax | 631-728-6506
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Provider Business Mailing Address
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Address Line | 1011 1ST AVE FL 10
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City | NEW YORK
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State | NY
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Zip | 10022-4112
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Country | US
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Telephone | 212-371-1000
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Fax | 212-371-1512
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHN FREIN
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Credential |
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Telephone | 212-371-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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