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General NPI Number Information
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NPI Number | 1972560167
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Entity Type | Organization
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Legal Business Name | SANCTUARY EAST LTD.
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Dates
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Enumeration Date | 04/30/2006
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 2 WILLIAM AVE
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City | EAST ISLIP
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State | NY
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Zip | 11730-2330
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Country | US
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Telephone | 631-224-7700
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Fax | 631-224-7600
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Provider Business Mailing Address
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Address Line | 2 WILLIAM AVE
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City | EAST ISLIP
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State | NY
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Zip | 11730-2330
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Country | US
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Telephone | 631-224-7700
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Fax | 631-224-7600
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Authorized Official
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Title or Position | DIRECTOR
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Name | LORENZO RODRIGUEZ
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Credential | A.A., CASAC
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Telephone | 631-224-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 070210970
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License Number State | NY
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