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NPI Code Detail

MEDICARE: ST.DOMINIC'S HOME

MEDICARE: ST.DOMINIC'S HOME
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility22280NY

Other Identifiers

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

General Provider Information

NPI Number : 1750349692
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST.DOMINIC'S HOME
Provider Business Mailing Address
First Line : 500 WESTERN HWY
Second Line :
City : BLAUVELT
State : NY
Zip : 10913-2000
Country : US
Telephone Number : 845-359-3400
Fax Number : 845-359-4253
Provider Business Practice Location Address
First Line : 500 WESTERN HWY
Second Line :
City : BLAUVELT
State : NY
Zip : 10913-2000
Country : US
Telephone Number : 845-359-3400
Fax Number : 845-359-4253
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : JUDITH D KYDON
Credential : MED
Telephone Number : 845-359-3400
Provider Enumeration Date : 05/02/2006
Last Update Date : 08/22/2020

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Directions to “ST.DOMINIC'S HOME ” Practice Location

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