Provider Demographics
NPI:1548347719
Name:SAMARITAN VILLAGE, INC.
Entity type:Organization
Organization Name:SAMARITAN VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-206-2000
Mailing Address - Street 1:138-02 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:718-206-2000
Mailing Address - Fax:718-206-4055
Practice Address - Street 1:55 WEST 125TH STREET
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-865-9182
Practice Address - Fax:212-662-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080911571261QR0405X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02718096Medicaid
NY080911571OtherOASAS LICENSED OUTPATIENT