| Creedmoor Addiction Treatment Center | |
|
80 45 Winchester Boulevard Building 19 Cbu 15 Queens Village NY 11427 | |
| (718) 264-3740 | |
| (718) 776-5145 |
| Full Name | Creedmoor Addiction Treatment Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 80 45 Winchester Boulevard, Queens Village, New York |
| Authorized Official Name and Position | Michael A Lawler (ASSOCIATE COMMISSIONER, DIVISION OF) |
| Authorized Official Contact | 5184575312 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Creedmoor Addiction Treatment Center 80 45 Winchester Boulevard Building 19 Cbu 15 Queens Village NY 11427 Ph: (718) 264-3740 | Creedmoor Addiction Treatment Center 80 45 Winchester Boulevard Building 19 Cbu 15 Queens Village NY 11427 Ph: (718) 264-3740 |
| NPI Number | 1619059052 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619059052 | NPI | - | NPPES |
| 01438233 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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