Provider Demographics
NPI:1043511926
Name:ST DOMINIC'S HOME
Entity Type:Organization
Organization Name:ST DOMINIC'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:KYDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-359-3400
Mailing Address - Street 1:500 WESTERN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913
Mailing Address - Country:US
Mailing Address - Phone:845-359-3400
Mailing Address - Fax:845-359-4023
Practice Address - Street 1:2340 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6001
Practice Address - Country:US
Practice Address - Phone:845-359-3400
Practice Address - Fax:845-359-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)