1154691368 NPI number — LEXINGTON CENTER FOR RECOVERY, INC.

Table of content: (NPI 1154691368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154691368 NPI number — LEXINGTON CENTER FOR RECOVERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEXINGTON CENTER FOR RECOVERY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154691368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2875 ROUTE 35 STE 6N1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATONAH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10536-3181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-666-0191
Provider Business Mailing Address Fax Number:
914-232-1218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 NORTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12601-1328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-486-2850
Provider Business Practice Location Address Fax Number:
845-486-2770
Provider Enumeration Date:
01/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TISNE
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
914-666-0191

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  100911477 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00729997 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: WO7831 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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