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General NPI Number Information
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NPI Number | 1982878757
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Entity Type | Organization
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Legal Business Name | SAMARITAN DAYTOP VILLAGE, INC.
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 14401 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11435-3601
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Country | US
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Telephone | 718-206-1990
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Fax | 718-206-0051
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Provider Business Mailing Address
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Address Line | 13802 QUEENS BLVD
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City | BRIARWOOD
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State | NY
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Zip | 11435-2642
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Country | US
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Telephone | 718-206-2000
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Fax | 718-206-4055
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Authorized Official
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Title or Position | VP OF HEALTH SERVICES & COMMUNITY B
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Name | CHARLES MADRAY
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Credential | MBA
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Telephone | 718-206-2000
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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 | 080311278
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License Number State | NY
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