Provider Demographics
NPI:1265672158
Name:GREEN CHIMNEYS CHILDRENS SERVICES
Entity Type:Organization
Organization Name:GREEN CHIMNEYS CHILDRENS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-279-2995
Mailing Address - Street 1:400 DOANSBURG RD
Mailing Address - Street 2:CALLER BOX 719
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-0719
Mailing Address - Country:US
Mailing Address - Phone:845-279-2995
Mailing Address - Fax:845-279-2714
Practice Address - Street 1:400 DOANSBURG RD
Practice Address - Street 2:CALLER BOX 719
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-0719
Practice Address - Country:US
Practice Address - Phone:845-279-2995
Practice Address - Fax:845-279-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02978958Medicaid
NY00328001Medicaid
NY02842579Medicaid
NY01138563Medicaid