MEDICARE: GREEN CHIMNEYS CHILDRENS SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265672158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN CHIMNEYS CHILDRENS SERVICES

Provider Business Mailing Address
First Line	:	400 DOANSBURG RD
Second Line	:	CALLER BOX 719
City	:	BREWSTER
State	:	NY
Zip	:	10509-0719
Country	:	US
Telephone Number	:	845-279-2995
Fax Number	:	845-279-2714

Provider Business Practice Location Address
First Line	:	400 DOANSBURG RD
Second Line	:	CALLER BOX 719
City	:	BREWSTER
State	:	NY
Zip	:	10509-0719
Country	:	US
Telephone Number	:	845-279-2995
Fax Number	:	845-279-2714

Authorized Official
Title or Position	:	CFO
Name	:	MR. ANGELO MATRA
Credential	:
Telephone Number	:	845-279-2995

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/05/2009

Similar Medicare Providers

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Practice Location Address:

400 DOANSBURG ROAD
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