Organization
SAMARITAN DAYTOP VILLAGE, INC.
Active
Organization
SAMARITAN DAYTOP VILLAGE, INC.
Active
Other names
Samaritan Village, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MADRAY MBA (VP OF HEALTH SERVICES & COMMUNITY B)
(718) 206-2000
Entity
Organization
Contact information
Practice address
14401 JAMAICA AVE, JAMAICA, NY 11435-3601
(718) 206-1990
(718) 206-0051
Mailing address
13802 QUEENS BLVD, BRIARWOOD, NY 11435-2642
(718) 206-2000
(718) 206-4055
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
080311278
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000245309
—
NY
01
—
080311278
OASAS LIC#
NY
01
—
16890
OASAS PROVIDER #
NY
01
—
PRU #6595
OASAS PROG,REPORT #
NY
Enumeration date
04/14/2008
Last updated
04/29/2016
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