Provider Demographics
NPI:1922470426
Name:SAMARITAN VILLAGE
Entity Type:Organization
Organization Name:SAMARITAN VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC 16784
Authorized Official - Phone:718-292-4455
Mailing Address - Street 1:302 E 119TH ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4213
Mailing Address - Country:US
Mailing Address - Phone:212-828-1656
Mailing Address - Fax:718-292-9228
Practice Address - Street 1:302 E 119TH ST APT 4B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4213
Practice Address - Country:US
Practice Address - Phone:212-828-1656
Practice Address - Fax:718-292-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization