Organization
SAMARITAN DAYTOP VILLAGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLVIN PINEDA (CREDENTIALING COORDINATOR)
(718) 206-2000
Entity
Organization
Contact information
Practice address
1521 JARRET PL, BRONX, NY 10461-2606
(718) 206-2000
Mailing address
13802 QUEENS BLVD STE 2, BRIARWOOD, NY 11435-2665
(718) 206-2000
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00245309
MEDICAID
NY
Enumeration date
02/04/2025
Last updated
02/04/2025
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