Organization
SANCTUARY EAST LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORENZO RODRIGUEZ A.A., CASAC (DIRECTOR)
(631) 224-7700
Entity
Organization
Contact information
Practice address
2 WILLIAM AVE, EAST ISLIP, NY 11730-2330
(631) 224-7700
(631) 224-7600
Mailing address
2 WILLIAM AVE, EAST ISLIP, NY 11730-2330
(631) 224-7700
(631) 224-7600
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
070210970
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004629536
AETNA
NY
05
—
01853901
—
NY
01
—
023048
EMPIRE B/C B/S
NY
01
—
105727591
UBH
NY
01
—
1058710
BEACON HEALTH
NY
01
—
160171
VALUE OPTIONS
NY
01
—
577470000
MAGELLAN
NY
01
—
MH20235
HIP
NY
01
—
OL987078
GHI
NY
Enumeration date
04/30/2006
Last updated
08/24/2011
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