NPIMap

Organization Active NPI

Samaritan Daytop Village, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Jamaica, NY
National Provider Identifier
1982878757
Registry record updated Apr 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
080311278 Issued in NY
Legal business name
SAMARITAN DAYTOP VILLAGE, INC.
Practice address
14401 Jamaica Ave
Jamaica, NY 11435-3601
Phone
(718) 206-1990
Fax
(718) 206-0051
NPI assigned
Apr 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2016

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

Authorized official

Name
Charles Madray, MBA
Title
VP of Health Services & Community B
Phone
(718) 206-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 080311278 NY Primary

Addresses

Primary practice location

14401 Jamaica Ave
Jamaica, NY 11435-3601

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
080311278OtherNYOASAS LIC#
16890OtherNYOASAS PROVIDER #
000245309MedicaidNY
PRU #6595OtherNYOASAS PROG,REPORT #

Other names 1

  • Samaritan Village, Inc. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Samaritan Village21 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": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461888000000",
    "number": "1982878757",
    "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": "14401 JAMAICA AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114353601",
            "telephone_number": "718-206-1990",
            "fax_number": "718-206-0051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN DAYTOP VILLAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2016-04-29",
        "status": "A",
        "authorized_official_last_name": "MADRAY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "VP OF HEALTH SERVICES & COMMUNITY B",
        "authorized_official_telephone_number": "718-206-2000",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NY",
            "license": "080311278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OASAS  LIC#",
            "identifier": "080311278",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OASAS PROVIDER #",
            "identifier": "16890",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000245309",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OASAS PROG,REPORT #",
            "identifier": "PRU #6595",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Village, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jamaica, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.