Basic Information
| Provider Information | |||||||||
| NPI: | 1376792663 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATHOLIC CHARITIES COMMUNITY SERVICES OF ORANGE COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109242157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452945124 | ||||||||
| FaxNumber: | 8452941369 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 SCOFIELD ST | ||||||||
| Address2: | |||||||||
| City: | WALDEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125861710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457785628 | ||||||||
| FaxNumber: | 8457785168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2008 | ||||||||
| LastUpdateDate: | 09/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHER | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8452945124 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D, L.C.S.W. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 100111579 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 02739311 | 05 | NY | MEDICAID |