Provider Demographics
NPI:1346386356
Name:VOLUNTEERS OF AMERICA-GNY
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA-GNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-390-5142
Mailing Address - Street 1:2015 FOREST AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1736
Mailing Address - Country:US
Mailing Address - Phone:718-390-5142
Mailing Address - Fax:718-876-5431
Practice Address - Street 1:2015 FOREST AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1736
Practice Address - Country:US
Practice Address - Phone:718-390-5142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02382832Medicaid
NY02752798Medicaid