Provider Demographics
NPI:1275756835
Name:SUPPORT CENTER INC.
Entity Type:Organization
Organization Name:SUPPORT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSCA
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:800-724-9322
Mailing Address - Street 1:188 ROUTE 209
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-5132
Mailing Address - Country:US
Mailing Address - Phone:800-724-9322
Mailing Address - Fax:845-858-3198
Practice Address - Street 1:188 ROUTE 209
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-5132
Practice Address - Country:US
Practice Address - Phone:800-724-9322
Practice Address - Fax:845-858-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility