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Organization

ST.DOMINIC'S HOME

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JUDY KYDON M.ED (CHIEF EXECUTIVE OFFICER)
(845) 359-3400
Entity
Organization

Contact information

Practice address
500 WESTERN HWY, BLAUVELT, NY 10913-2000
(845) 359-3400
(845) 359-4253
Mailing address
500 WESTERN HWY, BLAUVELT, NY 10913-2000
(845) 359-3400
(845) 359-4253

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
07159459
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02839536
NY
Enumeration date
03/05/2007
Last updated
09/20/2016
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