CRYSTAL RUN VILLAGE (NPI# 1619123999) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1619123999 |
Entity Type | Organization |
Organization Name | CRYSTAL RUN VILLAGE |
Practice Address |
601 Stony Ford Rd Middletown NY 10941-3951 |
Practice Telephone | 8456924444 |
Practice Fax Number | 8456951101 |
Mailing Telephone | 8456924444 |
Mailing Fax Number | 8456951101 |
Enumeration Date | 2008-08-18 |
Last Update Date | 2008-08-26 |
Authorized Official Name | MR. WILLIAM SAMMIS (DEPUTY ED OF ADMIN SERVICES) |
Authorized Official Telephone | 8456952559 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
Nursing & Custodial Care Facilities |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | CRYSTAL RUN VILLAGE | 601 Stony Ford Rd, Middletown, NY 10941-3951 |
Street Address |
601 STONY FORD RD |
City | MIDDLETOWN |
State | NY |
Zip Code | 10941-3951 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1386778546 | Crystal Run Village, Inc | Intermediate Care Facility, Mentally Retarded | 601 Stony Ford Rd, Middletown, NY 10941-3951 | 2007-03-16 |
1134407760 | Crystal Run Village, Inc. | Case Management | 601 Stony Ford Rd, Middletown, NY 10941-3951 | 2011-08-01 |
1619149077 | Crystal Run Village Inc | Intermediate Care Facility, Mentally Retarded | 601 Stony Ford Rd, Middletown, NY 10941-3951 | 2008-03-26 |
1619149069 | Crystal Run Village Inc | Intermediate Care Facility, Mentally Retarded | 601 Stony Ford Rd, Middletown, NY 10941-3951 | 2008-03-26 |
1083831036 | Crystal Run Village, Inc | Day Training, Developmentally Disabled Services | 601 Stony Ford Rd, Middletown, NY 10941 | 2007-04-19 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407471428 | Jackeline Montoya | Case Manager/Care Coordinator | 13 Kensington Manor, Middletown, NY 10941 | 2020-06-15 |
1124502398 | Kimberly Dominique Mccormick | Licensed Practical Nurse | 29, Macintosh Drive, Middletown, NY 10941 | 2018-09-24 |
1750891081 | Heather Skinner | Case Manager/Care Coordinator | 75 Crystal Run Rd Suite 201, Middletown, NY 10941 | 2017-09-29 |
1295281012 | Christa Lloyd | Counselor | 15 Fortune Rd, West Middletown, NY 10941 | 2016-08-31 |
1023471109 | Lauren Battaglia | Occupational Therapy Assistant | 192 Tower Drive Suite 400, Middletown, NY 10941 | 2016-04-05 |
1992188718 | Brynn Sierra | Occupational Therapist | 21 Riverside Drive, Middletown, NY 10941 | 2015-06-30 |
1356788574 | Keren Denis Joseph | Custodial Care Facility | 16 Disco Dr, Middletown, NY 10941 | 2013-05-29 |
1902169204 | Susan A. Reilly | Specialist | 2277 Gosen Turnpike, Middletown, NY 10941 | 2012-06-21 |
1518229392 | Dena Sapp | Case Manager/Care Coordinator | 75 Crystal Run Rd. Suite 201, Middletown, NY 10941 | 2012-06-08 |
1770800542 | Orange County Medical Transportation Inc. | Taxi | 80 Wisner Avenue, Middletown, NY 10941 | 2010-05-03 |
Find all providers in zip 10941 |
Taxonomy Code | 3104A0625X |
Grouping | Nursing & Custodial Care Facilities |
Classification | Assisted Living Facility |
Specialization | Assisted Living, Mental Illness |
A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578911921 | Leroy Manor | Assisted Living Facility | 8678 Lake Street Road, Leroy, NY 14482 | 2016-05-26 |
1043679384 | Blakes Income Tax Services | Assisted Living Facility | 4509 White Plains Road, Bronx, NY 10470 | 2016-02-15 |
1578909594 | Tanis Phillips | Assisted Living Facility | 98 Cathedral Ln, Cheektowaga, NY 14225-4612 | 2013-05-16 |
1770783813 | Loretto Geriatric Community Residence | Assisted Living Facility | 750 E Brighton Ave, Syracuse, NY 13205-2201 | 2007-07-18 |
1861526055 | Ohel Children's Home &family Services | Assisted Living Facility | 1217 Gateway Blvd, Far Rockaway, NY 11691 | 2007-03-16 |
1407913619 | Capital District Psychiatric Center | Assisted Living Facility | 75 New Scotland Ave, Albany, NY 12208-3409 | 2007-01-03 |
1407911928 | Middletown Psychiatric Center | Assisted Living Facility | 140 Old Orangeberg Rd, Orangeberg, NY 10962 | 2006-12-26 |
1588033609 | Nys Office of Mental Health | Assisted Living Facility | 140 Old Orangeburg Rd, Orangeburg, NY 10962-1157 | 2015-09-18 |
1487057972 | Mary Agnes Manor | Assisted Living Facility | 307 Porter Ave, Buffalo, NY 14201-1031 | 2014-09-29 |
1740683226 | Heritage Manor of Ransomville | Assisted Living Facility | 3509 Ransomville Rd, Ransomville, NY 14131-9602 | 2014-09-29 |
Find all providers with the same taxonomy |
City | MIDDLETOWN |
Zip Code | 10941 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.