MEDICARE: GREEN CHIMNEYS

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	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

General Provider Information

NPI Number	:	1487783932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN CHIMNEYS

Provider Business Mailing Address
First Line	:	PO BOX 719
Second Line	:
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 ROAD
Second Line	:
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	:	03/02/2007
Last Update Date	:	11/06/2014

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Directions to “GREEN CHIMNEYS ” Practice Location

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