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General NPI Number Information
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NPI Number | 1790974327
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Entity Type | Organization
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Legal Business Name | GREEN CHIMNEYS CHILDRENS SERVICES
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 400 DOANSBURG RD
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City | BREWSTER
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State | NY
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Zip | 10509-5902
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Country | US
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Telephone | 845-279-2995
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Fax | 845-279-2714
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Provider Business Mailing Address
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Address Line | PO BOX 719
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City | BREWSTER
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State | NY
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Zip | 10509-0719
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Country | US
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Telephone | 845-279-2995
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Fax | 845-279-2714
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Authorized Official
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Title or Position | CFO
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Name | MR. ANGELO MATRA
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Credential |
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Telephone | 845-279-2995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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