Provider Demographics
NPI:1093731069
Name:ST.CHRISTOPHER'S INN
Entity Type:Organization
Organization Name:ST.CHRISTOPHER'S INN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-335-1006
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:RT 9 GRAYMOOR
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-0150
Mailing Address - Country:US
Mailing Address - Phone:845-335-1000
Mailing Address - Fax:845-335-1017
Practice Address - Street 1:21 FRANCISCAN WAY
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-0150
Practice Address - Country:US
Practice Address - Phone:845-335-1000
Practice Address - Fax:845-335-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3953200R261Q00000X
NY324500000X
NY02125430324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01638375Medicaid