Organization
FIVE TOWNS COMMUNITY CENTER CODA PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LORENZO SISTRUNK M.A. (EXECUTIVE DIRECTOR)
(516) 239-6244
Entity
Organization
Contact information
Practice address
270 LAWRENCE AVE, CODA PROGRAM, LAWRENCE, NY 11559-1224
(516) 239-6244
(516) 371-2147
Mailing address
270 LAWRENCE AVE, CODA PROGRAM, LAWRENCE, NY 11559-1224
(516) 239-6244
(516) 371-2147
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02784169
—
NY
Enumeration date
03/23/2007
Last updated
05/12/2015
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