Provider Demographics
NPI:1972560167
Name:SANCTUARY EAST LTD.
Entity Type:Organization
Organization Name:SANCTUARY EAST LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:AA, CASAC
Authorized Official - Phone:631-224-7700
Mailing Address - Street 1:2 WILLIAM AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2330
Mailing Address - Country:US
Mailing Address - Phone:631-224-7700
Mailing Address - Fax:631-224-7600
Practice Address - Street 1:2 WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2330
Practice Address - Country:US
Practice Address - Phone:631-224-7700
Practice Address - Fax:631-224-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-30
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070210970261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY160171OtherVALUE OPTIONS
NY01853901Medicaid
NY004629536OtherAETNA
NY105727591OtherUBH
NY577470000OtherMAGELLAN
NYMH20235OtherHIP
NY023048OtherEMPIRE B/C B/S
NY1058710OtherBEACON HEALTH
NYOL987078OtherGHI
NY160171OtherVALUE OPTIONS