Provider Demographics
NPI:1205031598
Name:THE SALVATION ARMY
Entity Type:Organization
Organization Name:THE SALVATION ARMY
Other - Org Name:THE SALVATION ARMY - SAS
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT SECRETARY -LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-620-7330
Mailing Address - Street 1:440 WEST NYACK ROAD
Mailing Address - Street 2:PO BOX C-635
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1739
Mailing Address - Country:US
Mailing Address - Phone:845-620-7200
Mailing Address - Fax:845-620-7753
Practice Address - Street 1:677 SOUTH SALINA STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-479-5168
Practice Address - Fax:315-475-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01085487Medicaid
NY02702523Medicaid