Provider Demographics
NPI:1588793145
Name:THE SALVATION ARMY
Entity type:Organization
Organization Name:THE SALVATION ARMY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
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 1:865 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15233-1616
Practice Address - Country:US
Practice Address - Phone:412-231-0500
Practice Address - Fax:412-231-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA770450324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001381310007Medicare ID - Type UnspecifiedRESIDENTAIL TREATMENT