Provider Demographics
NPI:1215543376
Name:CENTRAL PARK RECOVERY
Entity Type:Organization
Organization Name:CENTRAL PARK RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:INTERVALLO
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:914-619-5242
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-0356
Mailing Address - Country:US
Mailing Address - Phone:914-619-5242
Mailing Address - Fax:
Practice Address - Street 1:2176 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1826
Practice Address - Country:US
Practice Address - Phone:914-447-6153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder