Organization
RE BLAISDELL ADDICTION TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A LAWLER (ASSOC COMMISIONER DIV OF FINANCIAL)
(518) 457-5312
Entity
Organization
Contact information
Practice address
140 OLD ORANGEBURG RD, BUILDING 57, ORANGEBURG, NY 10962-1157
(845) 359-8500
(845) 680-5510
Mailing address
BOX 140, ORANGEBURG, NY 10962-1129
(845) 359-8500
(845) 680-5510
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01432333
—
NY
Enumeration date
10/25/2006
Last updated
08/22/2020
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