Provider Demographics
NPI:1578805776
Name:LEXINGTON CENTER FOR RECOVERY, INC.
Entity Type:Organization
Organization Name:LEXINGTON CENTER FOR RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TISNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-666-0191
Mailing Address - Street 1:2875 ROUTE 35 STE 6N1
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3181
Mailing Address - Country:US
Mailing Address - Phone:914-666-0191
Mailing Address - Fax:913-232-1218
Practice Address - Street 1:706 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2038
Practice Address - Country:US
Practice Address - Phone:845-362-3904
Practice Address - Fax:845-362-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140311794261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03449281Medicaid
NYWO7831OtherMEDICARE ID