Provider Demographics
NPI:1306020896
Name:THE SALVATION ARMY
Entity Type:Organization
Organization Name:THE SALVATION ARMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY -LEGAL
Authorized Official - Prefix:MR
Authorized Official - First Name:RICAHRD
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-620-7330
Mailing Address - Street 1:P.O. BOX C-635
Mailing Address - Street 2:440 WEST NYACK ROAD
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1739
Mailing Address - Country:US
Mailing Address - Phone:845-620-7330
Mailing Address - Fax:845-620-7753
Practice Address - Street 1:120 WEST 14TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7301
Practice Address - Country:US
Practice Address - Phone:212-337-7433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6480440305R00000X
NY6480441305R00000X
NY7156441305R00000X
NY7281441305R00000X
NY7156440305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01600242Medicare PIN
NY00476155Medicare PIN