Provider Demographics
NPI:1225202708
Name:WESTON UNITED
Entity Type:Organization
Organization Name:WESTON UNITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-866-6040
Mailing Address - Street 1:321 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3637
Mailing Address - Country:US
Mailing Address - Phone:212-866-6040
Mailing Address - Fax:
Practice Address - Street 1:321 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3637
Practice Address - Country:US
Practice Address - Phone:212-866-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01305146320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness