Provider Demographics
NPI:1376808741
Name:GREAT ESCAPE SUBSTANCE ABUSE TRAINING AND INFORMATION
Entity Type:Organization
Organization Name:GREAT ESCAPE SUBSTANCE ABUSE TRAINING AND INFORMATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-670-3794
Mailing Address - Street 1:1900 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2455
Mailing Address - Country:US
Mailing Address - Phone:718-679-3794
Mailing Address - Fax:
Practice Address - Street 1:817 LIVONIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5621
Practice Address - Country:US
Practice Address - Phone:718-670-3794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1011251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)