Organization
ST.DOMINIC'S HOME,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH D KYDON MED (EXECUTIVE DIRECTOR)
(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
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
R7159431
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01310012
—
NY
Enumeration date
05/04/2006
Last updated
08/22/2020
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