Organization
DETOX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAIME VELEZ (LPN)
(347) 401-4659
Entity
Organization
Contact information
Practice address
214 CHARLES AVE, STATEN ISLAND, NY 10302-1122
(347) 401-4659
Mailing address
214 CHARLES AVE, STATEN ISLAND, NY 10302-1122
(347) 401-4659
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
299428-1
NY
Other
Enumeration date
12/05/2011
Last updated
12/05/2011
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