Provider Demographics
NPI:1346772019
Name:CATHOLIC CHARITIES OF THE DIOCESE OF ROCKVILLE CENTRE
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF ROCKVILLE CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BALCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-733-7032
Mailing Address - Street 1:90 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6232
Mailing Address - Country:US
Mailing Address - Phone:516-733-7040
Mailing Address - Fax:
Practice Address - Street 1:30 CARLOUGH RD STE C
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2919
Practice Address - Country:US
Practice Address - Phone:631-589-4144
Practice Address - Fax:631-589-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12049324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12049OtherOASAS OPERATING CERTIFICATE