MEDICARE: VOLUNTEERS OF AMERICA-GNY

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	320800000X	Mental Illness Community Based Residential Treatment Facility		NY

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

General Provider Information

NPI Number	:	1346386356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOLUNTEERS OF AMERICA-GNY

Provider Business Mailing Address
First Line	:	2015 FOREST AVE
Second Line	:	SUITE 2B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1736
Country	:	US
Telephone Number	:	718-390-5142
Fax Number	:	718-876-5431

Provider Business Practice Location Address
First Line	:	2015 FOREST AVE
Second Line	:	SUITE 2B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1736
Country	:	US
Telephone Number	:	718-390-5142
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. SHAWN SMITH
Credential	:
Telephone Number	:	718-390-5142

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	10/02/2008

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