Organization
SAMARITAN DAYTOP VILLAGE, INC.
Active
Other names
Samaritan Village, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES MADRAY (VICE PRESIDENT OF HEALTH & COMM)
(718) 764-4249
Entity
Organization
Contact information
Practice address
13020 89TH RD, RICHMOND HILL, NY 11418-3301
(718) 441-8913
(718) 805-6041
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
16890
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000245309
—
NY
01
—
03A0973
NYDS-DOH LICENSE #
NY
01
—
080510352
NYS-OASAS CD OPR.CERT.
NY
01
—
16890
NYS-OASAS PROVIDER #
NY
01
—
PRU-393
NYS-OASAS PROG.REPORT#
NY
Enumeration date
11/01/2006
Last updated
03/07/2023
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