Provider Demographics
NPI:1700869534
Name:VILLAGE ADULT DAY HEALTH CARE DAY TREATMENT PROGRAM
Entity Type:Organization
Organization Name:VILLAGE ADULT DAY HEALTH CARE DAY TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-337-5600
Mailing Address - Street 1:154 CHRISTOPHER ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2840
Mailing Address - Country:US
Mailing Address - Phone:212-337-5600
Mailing Address - Fax:212-337-5839
Practice Address - Street 1:644 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3307
Practice Address - Country:US
Practice Address - Phone:212-337-5878
Practice Address - Fax:212-337-5839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE CENTER FOR CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-25
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002335N261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01186305Medicaid