NPIMap

Organization Active NPI

Samaritan Daytop Village

  • Substance Abuse Rehabilitation Facility
  • Ellenville, NY
National Provider Identifier
1417494568
Registry record updated Jan 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
180110041 Issued in NY
Legal business name
SAMARITAN DAYTOP VILLAGE
Practice address
751 Briggs Highway
Ellenville, NY 12428
Phone
(718) 206-2000
Fax
(718) 206-4055
NPI assigned
Jan 27, 2017
Last updated
Jan 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2017

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

Authorized official

Name
James Hollywood, LCSW
Title
VP, Residential Treatment
Phone
(718) 206-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 180110041 NY Primary

Addresses

Primary practice location

751 Briggs Highway
Ellenville, NY 12428

Mailing address

13802 Queens Blvd
Briarwood, NY 11435-2642
Phone (718) 206-2000

Other identifiers 1

IdentifierTypeStateIssuer
00245309OtherNYMEDICAID

National Provider Directory

National Provider Directory
Tax ID family
Samaritan Village Harlem Outpatient21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1485475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485475200000",
    "number": "1417494568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13802 QUEENS BLVD",
            "city": "BRIARWOOD",
            "state": "NY",
            "postal_code": "114352642",
            "telephone_number": "718-206-2000",
            "fax_number": "718-206-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 BRIGGS HIGHWAY",
            "city": "ELLENVILLE",
            "state": "NY",
            "postal_code": "12428",
            "telephone_number": "718-206-2000",
            "fax_number": "718-206-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN DAYTOP VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-27",
        "last_updated": "2017-01-27",
        "status": "A",
        "authorized_official_last_name": "HOLLYWOOD",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "VP, RESIDENTIAL TREATMENT",
        "authorized_official_telephone_number": "718-206-2000",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NY",
            "license": "180110041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "00245309",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellenville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; 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.