NPIMap

Organization Active NPI

Faith Mission Alcohol Crisis Center

  • Substance Abuse Rehabilitation Facility
  • South Ozone Park, NY
National Provider Identifier
1740617315
Registry record updated Sep 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
140710094 Issued in NY
Legal business name
FAITH MISSION ALCOHOL CRISIS CENTER
Practice address
114-40 Van Wyck Expressway
South Ozone Park, NY 11420
Phone
(718) 322-3455
Fax
(718) 848-4152
NPI assigned
Sep 27, 2013
Last updated
Sep 27, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2013

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

Authorized official

Name
Mr. Maurice Lacey
Title
Executive Director
Phone
(718) 322-3455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 140710094 NY Primary

Addresses

Primary practice location

114-40 Van Wyck Expressway
South Ozone Park, NY 11420

Mailing address

114-40 Van Wyck Expressway
South Ozone Park, NY 11420
Phone (718) 322-3455

National Provider Directory

National Provider Directory

Locations

11440 Van Wyck Expy
South Ozone Park, NY 11420
Phone (718) 322-3455

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380240000000",
    "number": "1740617315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114-40 VAN WYCK EXPRESSWAY",
            "city": "SOUTH OZONE PARK",
            "state": "NY",
            "postal_code": "11420",
            "telephone_number": "718-322-3455",
            "fax_number": "718-848-4152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114-40 VAN WYCK EXPRESSWAY",
            "city": "SOUTH OZONE PARK",
            "state": "NY",
            "postal_code": "11420",
            "telephone_number": "718-322-3455",
            "fax_number": "718-848-4152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH MISSION ALCOHOL CRISIS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-27",
        "last_updated": "2013-09-27",
        "status": "A",
        "authorized_official_last_name": "LACEY",
        "authorized_official_first_name": "MAURICE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "718-322-3455",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NY",
            "license": "140710094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Ozone Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; 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.