Organization
SAMARITAN VILLAGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS APPLE (EXECUTIVE VP/COO)
(718) 206-2000
Entity
Organization
Contact information
Practice address
55 WEST 125TH STREET, 11TH FLOOR, NEW YORK, NY 10027
(212) 865-9182
(212) 662-9193
Mailing address
138-02 QUEENS BLVD, BRIARWOOD, NY 11435
(718) 206-2000
(718) 206-4055
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
080911571
NY
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02718096
—
NY
01
—
080911571
OASAS LICENSED OUTPATIENT
NY
Enumeration date
11/01/2006
Last updated
09/26/2013
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