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General NPI Number Information
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NPI Number | 1619123999
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Entity Type | Organization
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Legal Business Name | CRYSTAL RUN VILLAGE
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 601 STONY FORD RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-3951
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Country | US
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Telephone | 845-692-4444
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Fax | 845-695-1101
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Provider Business Mailing Address
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Address Line | 601 STONY FORD RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-3951
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Country | US
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Telephone | 845-692-4444
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Fax | 845-695-1101
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Authorized Official
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Title or Position | DEPUTY ED OF ADMIN SERVICES
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Name | MR. WILLIAM SAMMIS
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Credential |
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Telephone | 845-695-2559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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