NPIMap

Organization Active NPI

St.Dominic'S Home

  • Intellectual Disabilities Intermediate Care Facility
  • Blauvelt, NY
National Provider Identifier
1720117666
Registry record updated Sep 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
07159459 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
Mar 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2016

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

Authorized official

Name
Ms. Judy Kydon, M.ED
Title
Chief Executive Officer
Phone
(845) 359-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 07159459 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
02839536MedicaidNY

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": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474329600000",
    "number": "1720117666",
    "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": "2007-03-05",
        "last_updated": "2016-09-20",
        "status": "A",
        "authorized_official_last_name": "KYDON",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "845-359-3400",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.ED"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NY",
            "license": "07159459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02839536",
            "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 Sep 20, 2016; 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.