Provider Demographics
NPI:1023285186
Name:THE SALVATION ARMY
Entity type:Organization
Organization Name:THE SALVATION ARMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SOUTHWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-620-7329
Mailing Address - Street 1:440 WEST NYACK ROAD
Mailing Address - Street 2:PO BOX C-635
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1739
Mailing Address - Country:US
Mailing Address - Phone:845-620-7200
Mailing Address - Fax:845-620-7615
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:718-529-5410
Practice Address - Fax:718-329-5409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05174410Medicaid