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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