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General NPI Number Information
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NPI Number | 1528609799
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Entity Type | Organization
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Legal Business Name | EBDK AT CALVERTON
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 06/01/2020
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Provider Practice Location Address
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Address Line | 525 JAN WAY
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City | CALVERTON
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State | NY
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Zip | 11933-3005
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Country | US
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Telephone | 631-508-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 67 CLINTON RD
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City | GARDEN CITY
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State | NY
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Zip | 11530-4777
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROJECT MANAGER
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Name | ROBERT JAMES LENAHAN
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Credential |
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Telephone | 631-205-8699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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