Organization
SAMARITAN DAYTOP VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES HOLLYWOOD LCSW (VP, RESIDENTIAL TREATMENT)
(718) 206-2000
Entity
Organization
Contact information
Practice address
327 W 43RD ST, NEW YORK, NY 10036-6406
(212) 333-5445
Mailing address
13802 QUEENS BLVD, BRIARWOOD, NY 11435-2642
(718) 206-2000
(718) 206-4055
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
170110040
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00245309
MEDICAID
NY
Enumeration date
01/12/2017
Last updated
01/20/2017
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