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General NPI Number Information
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NPI Number | 1780725069
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Entity Type | Organization
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Legal Business Name | SLS RESIDENTIAL INC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2505 CARMEL AVE SUITE 210
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City | BREWSTER
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State | NY
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Zip | 10509
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Country | US
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Telephone | 845-279-5994
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Fax | 845-279-7678
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Provider Business Mailing Address
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Address Line | 2505 CARMEL AVE SUITE 210
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City | BREWSTER
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State | NY
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Zip | 10509
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Country | US
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Telephone | 845-279-5994
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Fax | 845-279-7678
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Authorized Official
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Title or Position | ADMINISTRATOR CFO
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Name | BETSY BERGMAN
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Credential |
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Telephone | 845-279-5994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 8490002
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License Number State | NY
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