Organization
ST.DOMINIC'S HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH D KYDON MED (EXECUTIVE DIRECTOR)
(845) 359-3400
Entity
Organization
Contact information
Practice address
500 WESTERN HWY, BLAUVELT, NY 10913-2000
(845) 359-3400
(845) 359-4253
Mailing address
500 WESTERN HWY, BLAUVELT, NY 10913-2000
(845) 359-3400
(845) 359-4253
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
07159460
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02573797
—
NY
Enumeration date
05/02/2006
Last updated
09/20/2016
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