Organization
CREEDMOOR ADDICTION TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A LAWLER (ASSOCIATE COMMISSIONER, DIVISION OF)
(518) 457-5312
Entity
Organization
Contact information
Practice address
80 45 WINCHESTER BOULEVARD, BUILDING 19 CBU 15, QUEENS VILLAGE, NY 11427
(718) 264-3740
(718) 776-5145
Mailing address
80 45 WINCHESTER BOULEVARD, BUILDING 19 CBU 15, QUEENS VILLAGE, NY 11427
(718) 264-3740
(718) 776-5145
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01438233
—
NY
Enumeration date
10/19/2006
Last updated
08/22/2020
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