Provider Demographics
NPI:1487709671
Name:LEXINGTON CENTER FOR RECOVERY, INC.
Entity type:Organization
Organization Name:LEXINGTON CENTER FOR RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TISNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-666-0191
Mailing Address - Street 1:2875 ROUTE 35 STE 6N1
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3181
Mailing Address - Country:US
Mailing Address - Phone:914-666-0191
Mailing Address - Fax:914-232-1218
Practice Address - Street 1:2875 ROUTE 35 STE 6N1
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-3181
Practice Address - Country:US
Practice Address - Phone:914-666-0191
Practice Address - Fax:914-238-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00729997Medicaid
NY01199577OtherMEDICAL TRANSPORTATION
NY00729997Medicaid