Provider Demographics
NPI:1700282258
Name:BELVEDERE
Entity Type:Organization
Organization Name:BELVEDERE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:845-564-0010
Mailing Address - Street 1:356 MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3038
Mailing Address - Country:US
Mailing Address - Phone:845-564-0010
Mailing Address - Fax:845-564-2579
Practice Address - Street 1:356 MEADOW AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3038
Practice Address - Country:US
Practice Address - Phone:845-564-0010
Practice Address - Fax:845-564-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03448515Medicaid