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General NPI Number Information
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NPI Number | 1396806881
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Entity Type | Organization
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Legal Business Name | SAINT JOHNS HOME FOR BOYS
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 150 BEACH 110TH STREET
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694
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Country | US
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Telephone | 718-945-2800
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Fax | 718-945-4662
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Provider Business Mailing Address
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Address Line | 150 BEACH 110TH STREET
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694
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Country | US
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Telephone | 718-945-2800
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Fax | 718-945-4662
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Authorized Official
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Title or Position | DIRECTOR OF SPECIAL SERVICES & OPER
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Name | MR. DARVING C IRIZARRY
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Credential | LMSW
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Telephone | 718-945-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State | NY
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