NPIMap

Organization Active NPI

St.Dominic'S Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Blauvelt, NY
National Provider Identifier
1376580092
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
22280 Issued in NY
Legal business name
ST.DOMINIC'S HOME
Practice address
500 Western Hwy
Blauvelt, NY 10913-2000
Phone
(845) 359-3400
Fax
(845) 359-4253
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judith D Kydon, M.ED
Title
Executive Director
Phone
(845) 359-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 22280 NY Primary

Addresses

Primary practice location

500 Western Hwy
Blauvelt, NY 10913-2000

Mailing address

500 Western Hwy
Blauvelt, NY 10913-2000
Phone (845) 359-3400

Other identifiers 1

IdentifierTypeStateIssuer
01494302MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Stdominic'S Home18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376580092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WESTERN HWY",
            "city": "BLAUVELT",
            "state": "NY",
            "postal_code": "109132000",
            "telephone_number": "845-359-3400",
            "fax_number": "845-359-4253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WESTERN HWY",
            "city": "BLAUVELT",
            "state": "NY",
            "postal_code": "109132000",
            "telephone_number": "845-359-3400",
            "fax_number": "845-359-4253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST.DOMINIC'S HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KYDON",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "845-359-3400",
        "authorized_official_credential": "M.ED"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NY",
            "license": "22280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01494302",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blauvelt, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.