Provider Demographics
NPI:1013428275
Name:THE SALVATION ARMY
Entity Type:Organization
Organization Name:THE SALVATION ARMY
Other - Org Name:THE SALVATION ARMY MENTAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY -LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-620-7330
Mailing Address - Street 1:120 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7301
Mailing Address - Country:US
Mailing Address - Phone:212-337-7439
Mailing Address - Fax:212-337-7279
Practice Address - Street 1:601 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-8245
Practice Address - Country:US
Practice Address - Phone:718-329-5410
Practice Address - Fax:718-329-5409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SALVATION ARMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)