MEDICARE: THE SALVATION ARMY

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	324500000X	Substance Abuse Rehabilitation Facility
2	251V00000X	Voluntary or Charitable Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1437103819	OTHER	OH	NPI

General Provider Information

NPI Number	:	1437103819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SALVATION ARMY

Provider Business Mailing Address
First Line	:	440 W NYACK RD
Second Line	:
City	:	WEST NYACK
State	:	NY
Zip	:	10994-1753
Country	:	US
Telephone Number	:	845-620-7200
Fax Number	:	845-620-7753

Provider Business Practice Location Address
First Line	:	1710 PROSPECT AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2322
Country	:	US
Telephone Number	:	216-781-3773
Fax Number	:	216-781-9535

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. MICHAEL JOHN SOUTHWICK
Credential	:
Telephone Number	:	845-620-7329

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/15/2017

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Directions to “THE SALVATION ARMY ” Practice Location

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