Provider Demographics
NPI:1811193915
Name:ROCKLAND HOSPITAL GUILD, INC.
Entity Type:Organization
Organization Name:ROCKLAND HOSPITAL GUILD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORVALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-680-5422
Mailing Address - Street 1:140 OLD ORANGEBURG RD
Mailing Address - Street 2:BLDG. 1 - ROOM 204
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1157
Mailing Address - Country:US
Mailing Address - Phone:845-680-5422
Mailing Address - Fax:845-680-5562
Practice Address - Street 1:140 OLD ORANGEBURG RD
Practice Address - Street 2:BLDG. 1 - ROOM 204
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1157
Practice Address - Country:US
Practice Address - Phone:845-680-5422
Practice Address - Fax:845-680-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6399431320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01305215Medicaid