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General NPI Number Information
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NPI Number | 1710113444
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Entity Type | Organization
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Legal Business Name | THE SALVATION ARMY
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 217 SYCAMORE ST
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City | OIL CITY
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State | PA
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Zip | 16301-1443
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Country | US
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Telephone | 814-677-4056
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Fax | 814-676-8690
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Provider Business Mailing Address
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Address Line | 440 WEST NYACK ROAD PO BOX C-635
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City | WEST NYACK
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State | NY
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Zip | 10994-1739
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Country | US
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Telephone | 845-620-7200
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Fax | 845-620-7615
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. MICHAEL JOHN SOUTHWICK
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Credential |
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Telephone | 845-620-7329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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