1295889806 NPI number — COUNTY OF ORANGE

Table of content: (NPI 1295889806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295889806 NPI number — COUNTY OF ORANGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF ORANGE
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:
COUNTY OF ORANGE, DEPARTMENT OF MENTAL HEALTH
Provider Other Organization Name Type Code:
5
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:
1295889806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 HARRIMAN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOSHEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10924-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-291-2600
Provider Business Mailing Address Fax Number:
845-291-2628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-568-5260
Provider Business Practice Location Address Fax Number:
845-568-5213
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
INDIRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM EVALUATION ASSISTANT
Authorized Official Telephone Number:
845-291-2902

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  7201105A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X , with the licence number: 7201105A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 7201105A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00542503 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03004253 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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