Listing of
Certified Chemical Dependence Treatment Providers
As of September 21, 2021
Division of Quality Assurance and Performance Improvement
Bureau of Certification
Janet L. Paloski, Director, Bureau of Certification 820 River St., Inc. Provider Number: 35210 Mr. Peter Newkirk, Chief Executive Officer Telephone - (518)-377-4228 Ext 202 Administrative Office: 428 Duane Avenue, Schenectady, NY 12304
Certificate Number: 181210136 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 111-113 Second Avenue, , Troy, New York 12180 Service Type: Supportive Living (819) PRU: 50863 Certified Capacity: 14
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10136_820Riv.pdf
Certificate Number: 201110640 Conditional Certificate Effective: 08/31/2020 Anticipated Recert Review: 11/30/2020 Program Location: 134 Franklin Street, Albany, New York 12202 Service Type: Outpatient Service (822) PRU: 51423 Certified Capacity: with Telepractice Designation
Program Name: Eleanor R. Young Memorial Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10640_820Riv.pdf
Certificate Number: 181211470 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 9-10 Saint Joseph's Terrace, Albany, New York 12210 Service Type: Supportive Living (819) PRU: 51903 Certified Capacity: 15 for women.
Program Name: Eleanor Young Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11470_820Riv.pdf
Certificate Number: 220111575 Renewal Effective: 02/01/2020 Anticipated Recert Review: 1/31/2022 Program Location: 551 Bay Road, Queensbury, New York 12804 Service Type: Outpatient Service (822) PRU: 52105 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11575_820Riv.pdf
Certificate Number: 200612187 Establishment Effective: 07/22/2019 Anticipated Recert Review: 6/30/2020 Program Location: 13 Crandall Street, , Glens Falls, New York 12801 Service Type: Residential Services (820) PRU: 53339 Certified Capacity: 21 for men
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Crandall St. Reintegration
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12187_820Riv.pdf
September 21, 2021 Page 1 of 225 A.R.E.B.A. - Casriel, Inc. d/b/a Addiction Care Interventions Provider Number: 11490 Ms. Hawa U. Jalloh MSW CASAC, Chief Executive Telephone - (929)-258-0059 Ext 1002 Administrative Office: Officer 589 Rockaway Avenue, Brooklyn, NY 11212
Certificate Number: 211210643 Establishment Effective: 01/29/2021 Anticipated Recert Review: 12/31/2021 Program Location: 8th Floor, 255 West 36th Street, , New York, New York 10018 Service Type: Outpatient Service (822) PRU: 3489 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Alcoholism Treatment Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10643_AREBAC.pdf
Certificate Number: 211211439 Amendment Effective: 04/01/2021 Anticipated Recert Review: 12/31/2021 Program Location: Pharmacy - 1st Floor, Floors 1-4, 589 Rockaway Avenue, , Brooklyn, New York 11212 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 51656 Certified Capacity: 135 with Telepractice Designation (w/ability to swing 45 beds between Medically Supervised Inpatient Withdrawal and Inpatient Rehab. services with the use of methadone)
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11439_AREBAC.pdf
Certificate Number: 211211447 Amendment Effective: 04/01/2021 Anticipated Recert Review: 12/31/2021 Program Location: Floors 3-5, 589 Rockaway Avenue, , Brooklyn, New York 11212 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51389 Certified Capacity: 46 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11447_AREBAC.pdf
AAA Health, Inc. Provider Number: 43710 Ms. Alla Papush, Administrator Telephone - (718)-421-2101 Administrative Office: 1090 Coney Island Ave., Brooklyn, NY 11230
Certificate Number: 221011468 Amendment Effective: 10/02/2020 Anticipated Recert Review: 10/31/2022 Program Location: 2nd Floor, 1090 Coney Island Avenue, Brooklyn, New York 11230 Service Type: Outpatient Service (822) PRU: 51953 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11468_AAAHea.pdf
Acacia Network, Inc. as Sponsor El Regreso, Inc. as Operator Provider Number: 1522 Mr. Raul Russi, Chief Executive Officer Telephone - (347)-649-3295 Administrative Office: 141-143 South 3rd Street, Brooklyn, NY 11211
September 21, 2021 Page 2 of 225 Certificate Number: 190210021 Establishment Effective: 03/12/2018 Anticipated Recert Review: 2/28/2019 Program Location: 834 East 156th Street, Bronx, New York 10455 Service Type: Intensive Residential Rehabilitation (819) PRU: 6093 Certified Capacity: 54 for men.
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10021_Acacia.pdf
Certificate Number: 190211487 Establishment Effective: 03/12/2018 Anticipated Recert Review: 2/28/2019 Program Location: 141-143 South Third Street, Brooklyn, New York 11211 Service Type: Intensive Residential Rehabilitation (819) PRU: 51995 Certified Capacity: 40 for women.
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11487_Acacia.pdf
Certificate Number: 220211511 Conditional Certificate Effective: 08/01/2021 Anticipated Recert Review: 2/28/2022 Program Location: 141-143 South 3rd Street, Brooklyn, New York 11211 Service Type: Outpatient Service (822) PRU: 6321 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11511_Acacia.pdf
Acacia Network, Inc. as Sponsor Greenhope Services for Women, Inc. as Operator Provider Number: 31030 Mr Raul Russi, CEO Telephone - (347)-649-3036 Administrative Office: 6th Floor, 300 E. 175th Street, Bronx, NY 10457
Certificate Number: 240212196 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/29/2024 Program Location: Basement & Floors 1-8, 435-439 East 119th Street, , New York, New York 10035 Service Type: Residential Services (820) PRU: 53353 Certified Capacity: 72 and up to 14 beds for children Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12196_Acacia.pdf
Acacia Network, Inc. as Sponsor, United Bronx Parents, Inc. as Operator Provider Number: 330 Mr. Raul Russi, Chief Executive Officer Telephone - (347)-649-3036 Administrative Office: 966 Prospect Avenue, Bronx, NY 10459
Certificate Number: 181210107 Amendment Effective: 06/19/2018 Anticipated Recert Review: 12/31/2018 Program Location: 773 Prospect Avenue, Bronx, New York 10455 Service Type: Intensive Residential Rehabilitation (819) PRU: 5750 Certified Capacity: 38 and up to 51 beds for children Program Name: Lorraine Montenegro Women and Children's Facility
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10107_Acacia.pdf
September 21, 2021 Page 3 of 225 Certificate Number: 181210553 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1st-4th Floors, 1006 East 151st Street, Bronx, New York 10455 Service Type: Intensive Residential Rehabilitation (819) PRU: 7258 Certified Capacity: 21 and up to 44 beds for children Program Name: La Casita III - The Mix
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10553_Acacia.pdf
Acacia Network, Inc. as Sponsor, Bronx Addiction Services Integrated Concepts System, Inc. as Operator Provider Number: 1857 Mr. Raul Russi, Chief Executive Officer Telephone - (347)-649-3036 Administrative Office: 6th floor, 300 East 175th Street, Bronx, NY 10457
Certificate Number: 240112165 Renewal Effective: 02/01/2021 Anticipated Recert Review: 1/31/2024 Program Location: [Sleeping Purposes Only for 15 beds at], 4th & 5th Floors, [Services Provided at], 1068 Franklin Avenue, 1064 Franklin Avenue, Bronx, New York 10456 Service Type: Residential Services (820) PRU: 53297 Certified Capacity: 130
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Franklin House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12165_Acacia.pdf
Acacia Network, Inc. as Sponsor, Queens Village Committee for Mental Health for Jamaica Community Adolesc Provider Number: 31340 Mr. Raul Russi, President & CEO Telephone - 347-649-3037 Administrative Office: 300 East 175th Street, Bronx, NY 11434
Certificate Number: 220210090 Establishment Effective: 03/19/2021 Anticipated Recert Review: 2/28/2022 Program Location: 116-30 Sutphin Boulevard, Jamaica, New York 11434 Service Type: Intensive Residential Rehabilitation (819) PRU: 1256 Certified Capacity: 192
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10090_Queens.pdf
Acacia Network, Inc. as Sponsor, The Puerto Rican Organization to Motivate, Enlighten and Serve Addicts, Inc. ( Provider Number: 166 Mr. Raul Russi, Chief Executive Officer Telephone - (347)-649-3037 Ext 3036 Administrative Office: 1776 Clay Avenue, Bronx, NY 10457
Certificate Number: 220910351 Amendment OASAS Host Effective: 09/01/2021 Anticipated Recert Review: 9/30/2022 Program Location: 1st & 3rd Floors, 1776 Clay Avenue, , Bronx, New York 10457 Service Type: Residential Opioid Treatment Program (822) PRU: 1183 Certified Capacity: 110 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10351_Acacia.pdf
Certificate Number: 210911066 Amendment Effective: 07/03/2020 Anticipated Recert Review: 9/30/2021 Program Location: , New York
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11066_Acacia.pdf
September 21, 2021 Page 4 of 225 Certificate Number: 211011618 Renewal Effective: 11/01/2018 Anticipated Recert Review: 10/31/2021 Program Location: 2nd Floor, 1776 Clay Avenue, Bronx, New York 10457 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 52099 Certified Capacity: 30 - with the use of methadone [up to 2 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11618_Acacia.pdf
Certificate Number: 240311627 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: 2nd Floor, 1776 Clay Avenue, Bronx, New York 10457 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 52108 Certified Capacity: 23 [up to 2 of these beds may be used for the provision of Section 816.7 medically supervised inpatent withdrawal & stabilization services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11627_Acacia.pdf
Certificate Number: 230411638 Renewal Effective: 05/01/2020 Anticipated Recert Review: 4/30/2023 Program Location: Administrative Site: Floors 1 & 2, Services: Floors 3, 4 & 5, 311 East 175th Street, Bronx, New York 10457 Service Type: Residential Rehabilitation Services for Youth (817) PRU: 2 Certified Capacity: 40
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11638_Acacia.pdf
Certificate Number: 220311834 Amendment Effective: 09/01/2020 Anticipated Recert Review: 3/31/2022 Program Location: 4th Floor, 175 Central Avenue, Albany, New York 12206 Service Type: Outpatient Service (822) PRU: 52747 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11834_Acacia.pdf
Certificate Number: 231111848 Renewal OASAS Host Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: 1st & 2nd Floor, 254 Virginia Street, Buffalo, New York 14201 Service Type: Outpatient Service (822) PRU: 52766 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11848_Acacia.pdf
September 21, 2021 Page 5 of 225 Certificate Number: 210911852 Amendment OASAS Host Effective: 11/18/2020 Anticipated Recert Review: 9/30/2021 Program Location: 1st & 2nd Floor, 254 Virginia Street, Buffalo, New York 14201 Service Type: Opioid Treatment Program (822) PRU: 52775 Certified Capacity: 200 with Telepractice Designation Capacity Lifted Program Name: Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11852_Acacia.pdf
Certificate Number: 231211856 Renewal OASAS Host Effective: 01/01/2021 Anticipated Recert Review: 12/31/2023 Program Location: 1st and 4th Floor, 175 Central Avenue, , Albany, New York 12206 Service Type: Opioid Treatment Program (822) PRU: 52785 Certified Capacity: 400 with Telepractice Designation Capacity Lifted Program Name: Camino Nuevo Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11856_Acacia.pdf
Certificate Number: 240311914 Amendment OASAS Host Effective: 04/27/2021 Anticipated Recert Review: 3/31/2024 Program Location: 1st - 4th Floors, 561 Court Street, , Brooklyn, New York 11231 Service Type: Opioid Treatment Program (822) PRU: 52884 Certified Capacity: 850 with Telepractice Designation Capacity Lifted Program Name: Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11914_Acacia.pdf
Certificate Number: 200811936 Amendment Effective: 07/03/2020 Anticipated Recert Review: 8/31/2020 Program Location: 1st - 4th Floors, 561 Court Street, Brooklyn, New York 11231 Service Type: Outpatient Service (822) PRU: 52898 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11936_Acacia.pdf
September 21, 2021 Page 6 of 225 Certificate Number: 231011964 Renewal OASAS Host Effective: 11/01/2020 Anticipated Recert Review: 10/31/2023 Program Location: 754 East 151st Street, , Bronx, New York 10455 Service Type: Opioid Treatment Program (822) PRU: 52934 Certified Capacity: 800 with Telepractice Designation Capacity Lifted Program Name: Ramon Velez Recovery Center Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11946_Acacia.pdf
Certificate Number: 211012043 Amendment Effective: 12/03/2020 Anticipated Recert Review: 10/31/2021 Program Location: 1st Floor, 754 East 151st Street, Bronx, New York 10455 Service Type: Outpatient Service (822) PRU: 53022 Certified Capacity: with Telepractice Designation
Program Name: Ramon Velez Recovery Center Outpatient Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12043_Acacia.pdf
Certificate Number: 220812274 Establishment Effective: 09/01/2021 Anticipated Recert Review: 8/31/2022 Program Location: 1st & 3rd Floors, 1776 Clay Avenue, , Bronx, New York 10457 Service Type: Outpatient Service (822) PRU: 53582 Certified Capacity: 0 with Telepractice Designation
Program Name: Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Service Type: Opioid Treatment Program (822) PRU: 53581 Certified Capacity: 550 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Access: Supports for Living Inc. Provider Number: 40310 Mr. Ronald Colavito, Executive Director Telephone - (845)-673-7077 Administrative Office: 15 Fortune Road West, Middletown, NY 10941
Certificate Number: 220112185 Amendment OMH Host Effective: 06/15/2021 Anticipated Recert Review: 1/31/2022 Program Location: Offices: 132, 133, and 134, 16-24 Union Street, , Middletown, New York 10940 Service Type: Outpatient Service (822) PRU: 53326 Certified Capacity: with Telepractice Designation
Program Name: Access: Recovery
Offices: 303, 304, and 308, 21-23 Grand Street, Newburgh, NY 12550 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12185_Access.pdf
September 21, 2021 Page 7 of 225 Action for a Better Community, Incorporated Provider Number: 37090 Mr. Jerome Underwood, President and CEO Telephone - (585)-325-5116 Administrative Office: 400 West Avenue, Rochester, NY 14611
Certificate Number: 210710645 Amendment Effective: 07/01/2020 Anticipated Recert Review: 7/31/2021 Program Location: Basement and 1st Floors, 33 Chestnut Street, Rochester, New York 14604 Service Type: Outpatient Service (822) PRU: 50519 Certified Capacity: with Telepractice Designation
Program Name: New Directions
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10645_Action.pdf
The Addiction Center of Broome County, Inc. Provider Number: 36030 Ms. Carmela Pirich, Executive Director Telephone - (607)-723-7308 Ext 124 Administrative Office: Colonial Plaza, 2nd Floor, 30 West State Street, Binghamton, NY 13901
Certificate Number: 231211044 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2023 Program Location: Colonial Plaza, 2nd Floor, 30 West State Street, Binghamton, New York 13901 Service Type: Outpatient Service (822) PRU: 50396 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51980 Certified Capacity: with Telepractice Designation
Program Name:
306 Main Street, Endicott, NY 13760 Additional Location(s) At:
Children's Home of Wyoming Conference, 1182 Chenango Street, Binghamton, NY 13901 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11044_Addict.pdf
Addictions Care Center of Albany, Inc. Provider Number: 35090 Mr. Keith W. Stack, Executive Director Telephone - (518)-465-5470 Ext 214 Administrative Office: Administration Building, 90 McCarty Avenue, Albany, NY 12202
Certificate Number: 200610128 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 6/30/2020 Program Location: 90 McCarty Avenue, , Albany, New York 12202 Service Type: Supportive Living (819) PRU: 51256 Certified Capacity: 38
Program Name: Albany Citizens Council Supportive Living
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10128_Addict.pdf
September 21, 2021 Page 8 of 225 Certificate Number: 230910605 Renewal Effective: 10/01/2020 Anticipated Recert Review: 9/30/2023 Program Location: 1044 Broadway, Menands, New York 12204 Service Type: Outpatient Service (822) PRU: 50113 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10605_Addict.pdf
Certificate Number: 220212137 Amendment Effective: 06/16/2021 Anticipated Recert Review: 2/28/2022 Program Location: 90 McCarty Avenue, , Albany, New York 12202 Service Type: Residential Services (820) PRU: 53212 Certified Capacity: 16 with Telepractice Designation for women and up to 4 beds for children
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Treatment, Recovery, Education and Empowerment (T.R.E.E.) House for Women and Child
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12137_Addict.pdf
Certificate Number: 200912207 Establishment Effective: 10/14/2019 Anticipated Recert Review: 9/30/2020 Program Location: 90 McCarty Avenue, , Albany, New York 12202 Service Type: Residential Services (820) PRU: 53459 Certified Capacity: 24 with Telepractice Designation [for men]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: McCarty Avenue Men's Stabilization/Rehabilitation
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12207_Addict.pdf
Certificate Number: 201112210 Amendment Effective: 02/03/2020 Anticipated Recert Review: 11/30/2020 Program Location: 79 Glenwood Avenue, , Queensbury, New York 12804 Service Type: Residential Services (820) PRU: 53545 Certified Capacity: 16 with Telepractice Designation and up to 2 beds for children Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Glenwood House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12210_Addict.pdf
Certificate Number: 220112255 Establishment Effective: 02/06/2021 Anticipated Recert Review: 1/31/2022 Program Location: 111 McCarty Avenue, , Albany, New York 12202 Service Type: Residential Services (820) PRU: 53540 Certified Capacity: 14 for women and up to 6 beds for their children
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Vista House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12255_Addict.pdf
Addicts Rehabilitation Center Fund, Inc. Provider Number: 19 Rev. Reginald Williams, President and CEO Telephone - (646)-783-5331 Ext 217 Administrative Office: 1881 Park Avenue, New York, NY 10035
September 21, 2021 Page 9 of 225 Certificate Number: 181212079 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1881 Park Avenue, New York, New York 10035 Service Type: Residential Services (820) PRU: 53111 Certified Capacity: 216
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12079_Addict.pdf
Advanced Human Services, Inc. Provider Number: 42660 Anna Rikhter M.D., President Telephone - (718)-261-3437 Administrative Office: 112-15 72nd Road, Forest Hills, NY 11375
Certificate Number: 181211467 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Suite LL1, Basement, 112-15 72nd Road, Forest Hills, New York 11375 Service Type: Outpatient Service (822) PRU: 51859 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11467_Advanc.pdf
Certificate Number: 181211763 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Basement, 112-15 72nd Road, Forest Hills, New York 11375 Service Type: Medically Supervised Outpatient Withdrawal & Stabilization (816.8) PRU: 52612 Certified Capacity: 30 with Telepractice Designation [without the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11763_Advanc.pdf
AIDS Service Center of Lower Manhattan, Inc. d/b/a Alliance for Positive Change Provider Number: 48900 Ms. Sharen I. Duke, President/Chief Executive Telephone - (212)-645-0875 Ext 304 Administrative Office: Officer 64 West 35th Street, New York, NY 10001
Certificate Number: 231011858 Renewal Effective: 11/01/2020 Anticipated Recert Review: 10/31/2023 Program Location: Ground Floor, 2036 Amsterdam Avenue, , New York, New York 10032 Service Type: Outpatient Service (822) PRU: 52799 Certified Capacity: with Telepractice Designation
Program Name: CASA Washington Heights
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11858_AIDSSe.pdf
Albany County Department of Mental Health Provider Number: 70520 Stephen J. Giordano Ph.D., Director Telephone - (518)-447-4567 Administrative Office: 175 Green Street, Albany, NY 12202
September 21, 2021 Page 10 of 225 Certificate Number: 231110648 Renewal OMH Host Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: 1st and 2nd Floors, 260 South Pearl Street, Albany, New York 12202 Service Type: Outpatient Service (822) PRU: 1865 Certified Capacity:
Program Name: Albany County Alcohol and Substance Abuse Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10648_Albany.pdf
Alcohol and Drug Council of Tompkins County, Inc. Provider Number: 36070 Ms. Angela D. Sullivan, Executive Director Telephone - (607)-274-6288 Administrative Office: Suite 500, 201 East Green Street, Ithaca, NY 14850
Certificate Number: 220410653 Amendment Effective: 10/28/2020 Anticipated Recert Review: 4/30/2022 Program Location: Suite 500, 5th Floor, 201 East Green Street, Ithaca, New York 14850 Service Type: Outpatient Service (822) PRU: 50615 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10653_Alcoho.pdf
Alcohol and Substance Abuse Council of Jefferson County, Inc. d/b/a Pivot Provider Number: 36130 Mr. William W. Bowman, Executive Director Telephone - (315)-788-4660 Administrative Office: Suite 320, 167 Polk Street, Watertown, NY 13601
Certificate Number: 220311991 Renewal Effective: 04/01/2020 Anticipated Recert Review: 3/31/2022 Program Location: Administrative Site Only:, Suite 320, 167 Polk Street, Watertown, New York 13601 Service Type: Prevention Counseling PRU: 90689 Certified Capacity:
Program Name:
Watertown High School, Level 3, Balcony Office, 1335 Washington Street, Watertown, NY 13601 Other Service Site(s) At: West Carthage Elementary School, 31568 Cole Road, Carthage, NY 13619 Other Service Site(s) At: Carthage Elementary School, Beaver Lane, Carthage, NY 13619 Other Service Site(s) At: Ohio Elementary School, 1537 Ohio Street, Watertown, NY 13601 Other Service Site(s) At: Alexandria Bay Central School District, 2nd Floor, Room 307, 34 Bolton Avenue, Alexandria Bay, NY 13607 Other Service Site(s) At: Case Middle School, 1st Floor, Guidance Office, 1237 Washington Street, Watertown, NY 13601 Other Service Site(s) At: North Elementary School, 171 East Hoard Street, Watertown, NY 13601 Other Service Site(s) At: Carthage High School, Guidance Office, 36500 Route 26, Carthage, NY 13619 Other Service Site(s) At: General Brown Junior-High School, Room 117, 17643 Cemetery Road, Dexter, NY 13634 Other Service Site(s) At:
September 21, 2021 Page 11 of 225 LaFargeville Central School, 20414 Sunrise Avenue, LaFargeville, NY 13656 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11991_Alcoho.pdf
The Alcohol and Substance Abuse Prevention Council of Saratoga County Provider Number: 35250 Ms. Janine Stuchin, Executive Director Telephone - (518)-581-1230 Ext 3611 Administrative Office: 125 High Rock Avenue, Saratoga Springs, NY 12866
Certificate Number: 230211992 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/28/2023 Program Location: Administrative Site Only:, 125 High Rock Avenue, Saratoga Springs, New York 12866 Service Type: Prevention Counseling PRU: 90681 Certified Capacity:
Program Name:
Oliver W. Winch Middle School, 1st Floor, Guidance Office, 99 Hudson Street, South Glens Falls, NY 12803 Other Service Site(s) At: South Glens Falls High School, 1st Floor, Guidance Office, 42 Merritt Road, South Glens Falls, NY 12803 Other Service Site(s) At: Corinth Middle-High School, 1st Floor, Guidance Suites, 105 Oak Street, Corinth, NY 12822 Other Service Site(s) At: Ballston Spa High School, 1st Floor, Student Services, 220 Ballston Avenue, Ballston Spa, NY 12020 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11992_TheAlc.pdf
Alcoholism and Substance Abuse Council of Schenectady County, Inc. d/b/a New Choices Recovery Center Provider Number: 35060 Ms. Laura Combs, Executive Director Telephone - (518)-348-7968 Administrative Office: 728 State Street, Schenectady, NY 12307
Certificate Number: 230210589 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/28/2023 Program Location: 1st & 2nd Floors, 728 State Street, Schenectady, New York 12307 Service Type: Outpatient Service (822) PRU: 50332 Certified Capacity: with Telepractice and Problem Gambling Designations
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51966 Certified Capacity: with Telepractice Designation
Program Name:
122 Park Avenue, Schenectady, NY 12304 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10589_Alcoho.pdf
Certificate Number: 200711825 Amendment Effective: 06/10/2020 Anticipated Recert Review: 7/31/2020 Program Location: 840 State Street, , Schenectady, New York 12307 Service Type: Outpatient Service (822) PRU: 52777 Certified Capacity: with Telepractice Designation with Problem Gambling Designation
Program Name:
September 21, 2021 Page 12 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11825_Alcoho.pdf
Certificate Number: 220412259 Establishment Effective: 05/03/2021 Anticipated Recert Review: 4/30/2022 Program Location: 406-408 Summit Avenue, , Schenectady, New York 12307 Service Type: Residential Services (820) PRU: 53548 Certified Capacity: 16
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Purcell House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220412260 Establishment Effective: 05/03/2021 Anticipated Recert Review: 4/30/2022 Program Location: 575 Lansing Street, , Schenectady, New York 12303 Service Type: Residential Services (820) PRU: 53547 Certified Capacity: 21
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Georgia S. Perrin House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220412261 Establishment Effective: 05/03/2021 Anticipated Recert Review: 4/30/2022 Program Location: 834 Emmett Street, , Schenectady, New York 12307 Service Type: Residential Services (820) PRU: 53549 Certified Capacity: 21
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Margaret T. Smith House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220412262 Establishment Effective: 05/03/2021 Anticipated Recert Review: 4/30/2022 Program Location: 70 and 72 Union Avenue, , Schenectady, New York 12308 Service Type: Residential Services (820) PRU: 53546 Certified Capacity: 22
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Bridge Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Allegany Council on Alcoholism and Substance Abuse, Inc. Provider Number: 38110 Mr. William J. Penman, Executive Director Telephone - (585)-593-1920 Ext 722 Administrative Office: 3084 Trapping Brook Road, Wellsville, NY 14895
Certificate Number: 191210170 Renewal Effective: 01/02/2018 Anticipated Recert Review: 12/31/2019 Program Location: 3084 Trapping Brook Road, Wellsville, New York 14895 Service Type: Community Residential (819) PRU: 50178 Certified Capacity: 17
Program Name: Trapping Brook House
Service Type: Supportive Living (819) PRU: 51068 Certified Capacity: 10
Program Name: Trapping Brook Supportive Living
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10170_Allega.pdf
September 21, 2021 Page 13 of 225 Certificate Number: 240410658 Renewal Effective: 05/01/2021 Anticipated Recert Review: 4/30/2024 Program Location: 2956 Airway Road, Wellsville, New York 14895 Service Type: Outpatient Service (822) PRU: 50177 Certified Capacity: with Telepractice Designation
Program Name:
40 West Main Street, Cuba, NY 14727 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10658_Allega.pdf
Amethyst House, Inc. Provider Number: 31330 Ms. Angela A. DeSanno, Executive Director Telephone - (917)-816-1929 Administrative Office: 280 Richmond Terrace, Staten Island, NY 10301
Certificate Number: 190110089 Amendment Effective: 01/01/2018 Anticipated Recert Review: 1/31/2019 Program Location: 220 Heberton Avenue , , Staten Island, New York 10302 Service Type: Community Residential (819) PRU: 51041 Certified Capacity: 20
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10089_Amethy.pdf
Anchor House, Inc. Provider Number: 610 Ms. Alison King, Executive Director Telephone - (718)-771-0760 Ext 101 Administrative Office: APT, 1041-47 Bergen Street, Brooklyn, NY 11216
Certificate Number: 220112128 Conditional Certificate Effective: 02/01/2021 Anticipated Recert Review: 1/31/2022 Program Location: 976 Park Place, , Brooklyn, New York 11213 Service Type: Residential Services (820) PRU: 53207 Certified Capacity: 28 with Telepractice Designation (women)
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12128_Anchor.pdf
Certificate Number: 210712129 Conditional Certificate Effective: 02/01/2021 Anticipated Recert Review: 7/31/2021 Program Location: 1041-1047 Bergen Street, , Brooklyn, New York 11216 Service Type: Residential Services (820) PRU: 53208 Certified Capacity: 50 (men) with Telepractice
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12129_Anchor.pdf
Argus Community, Inc. Provider Number: 10160 Mr. Richard Weiss, President and Chief Executive Telephone - (917)-589-6322 Administrative Office: Officer Room 209, 2nd Floor, 760 East 160th Street, Bronx, NY 10456
September 21, 2021 Page 14 of 225 Certificate Number: 181210001 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 402 East 156th Street, Bronx, New York 10455 Service Type: Intensive Residential Rehabilitation (819) PRU: 5960 Certified Capacity: 59
Program Name: Harbor House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10001_ArgusC.pdf
Certificate Number: 181210002 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 3rd Floor, 760 East 160th Street, , Bronx, New York 10456 Service Type: Intensive Residential Rehabilitation (819) PRU: 4200 Certified Capacity: 50
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10002_ArgusC.pdf
Certificate Number: 231011505 Renewal Effective: 11/01/2020 Anticipated Recert Review: 10/31/2023 Program Location: 2nd Floor - Room #s 201, 202, 207, 221, 223, 225, 227, 229 & 232, 1st Floor - Room #108, 760 East 160th Street, Bronx, New York 10456 Service Type: Outpatient Service (822) PRU: 227 Certified Capacity: with Telepractice Designation
Program Name: The Elizabeth L. Sturz Outpatient Center
Floor #s 1 and 2, 226 East 144th Street, Bronx, NY 10451 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11505_ArgusC.pdf
Certificate Number: 240211781 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/29/2024 Program Location: 2038 Davidson Avenue, Bronx, New York 10453 Service Type: Prevention Counseling PRU: 90867 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11781_ArgusC.pdf
Certificate Number: 210511782 Amendment Effective: 09/09/2020 Anticipated Recert Review: 5/31/2021 Program Location: 507 West 145th Street, New York, New York 10031 Service Type: Outpatient Service (822) PRU: 52628 Certified Capacity: with Telepractice Designation
Program Name:
1st Floor, 2015 Madison Avenue, New York , NY 10035 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11782_ArgusC.pdf
Certificate Number: 181211783 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Basement-5th Floor, 202-204 Edgecombe Avenue, New York, New York 10030 Service Type: Intensive Residential Rehabilitation (819) PRU: 52629 Certified Capacity: 60
Program Name: Striver House
September 21, 2021 Page 15 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11783_ArgusC.pdf
Certificate Number: 181212113 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 114-40 Van Wyck Expressway, South Ozone Park, New York 11420 Service Type: Medically Monitored Withdrawal & Stabilization Services (816.9) PRU: 53156 Certified Capacity: 36
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12113_ArgusC.pdf
Certificate Number: 240112154 Renewal Effective: 02/01/2021 Anticipated Recert Review: 1/31/2024 Program Location: 2nd, 3rd & 4th Floors, 2015-25 Madison Avenue, , New York, New York 10035 Service Type: Residential Services (820) PRU: 53274 Certified Capacity: 150
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Mary S. Taylor Homeless Outreach Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12154_ArgusC.pdf
Argus Community, Inc. as Sponsor Create, Inc. as Operator Provider Number: 296 Mr. Richard Weiss, President/CEO Telephone - (718)-401-5700 Administrative Office: 760 East 160th Street, Bronx, NY 10456
Certificate Number: 210810743 Establishment Effective: 09/16/2020 Anticipated Recert Review: 8/31/2021 Program Location: 1st & 2nd Floors, Basement, 73-75 Lenox Avenue, New York, New York 10026 Service Type: Outpatient Service (822) PRU: 658 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10743_Create.pdf
Certificate Number: 210812084 Establishment Effective: 09/16/2020 Anticipated Recert Review: 8/31/2021 Program Location: 121-123 West 111th Street, New York, New York 10026 Service Type: Residential Services (820) PRU: 53116 Certified Capacity: 32
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12084_ArgusC.pdf
Argus Community, Inc. as Sponsor, Counseling Service of E.D.N.Y., Inc. as Operator Provider Number: 80 Mr. Richard Weiss, President/CEO Telephone - (718)-401-5700 Administrative Office: 760 East 160th Street , Bronx, NY 10456
Certificate Number: 211010740 Establishment Effective: 11/20/2020 Anticipated Recert Review: 10/31/2021 Program Location: 9th Floor, 175 Remsen Street, Brooklyn, New York 11201 Service Type: Outpatient Service (822) PRU: 6285 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
September 21, 2021 Page 16 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10740_Counse.pdf
Certificate Number: 211010741 Establishment Effective: 11/20/2020 Anticipated Recert Review: 10/31/2021 Program Location: Suite 300, 175 Fulton Avenue, , Hempstead, New York 11550 Service Type: Outpatient Service (822) PRU: 5726 Certified Capacity: 0 with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10741_Counse.pdf
Certificate Number: 211011478 Establishment Effective: 11/20/2020 Anticipated Recert Review: 10/31/2021 Program Location: Kings County District Attorney's Office, 3rd Floor, 210 Joralemon Street, Brooklyn, New York 11201 Service Type: Outpatient Service (822) PRU: 51993 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11478_Counse.pdf
Certificate Number: 211011601 Establishment Effective: 11/20/2020 Anticipated Recert Review: 10/31/2021 Program Location: Suite 501, 5th Floor, 163-18 Jamaica Avenue, Jamaica, New York 11432 Service Type: Outpatient Service (822) PRU: 52083 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11601_Counse.pdf
Arms Acres, Inc. Provider Number: 32412 Ms. Patrice Wallace-Moore, Chief Executive Officer Telephone - (845)-225-3400 Ext 6131 Administrative Office: 75 Seminary Hill Road, Carmel, NY 10512
Certificate Number: 210810097 Amendment Effective: 02/23/2021 Anticipated Recert Review: 8/31/2021 Program Location: A, B, and E Wings, Basement & 1st Floor, 75 Seminary Hill Road, , Carmel, New York 10512 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50795 Certified Capacity: 152 with Telepractice Designation [with the use of methadone] [Up to 22 of these beds may be used for the provision of Part 816.7 medically supervised inpatient withdrawal & stabilization service as needed]
Program Name: Arms Acres Adult Unit
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10097_ArmsAc.pdf
Certificate Number: 210810665 Amendment Effective: 05/29/2020 Anticipated Recert Review: 8/31/2021 Program Location: 7th Floor, 80-02 Kew Gardens Road, Kew Gardens, New York 11415 Service Type: Outpatient Service (822) PRU: 7248 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10665_ArmsAc.pdf
September 21, 2021 Page 17 of 225 Certificate Number: 200810666 Amendment Effective: 07/31/2020 Anticipated Recert Review: 8/31/2020 Program Location: 1st Floor, 21 Old Route 6, , Carmel, New York 10512 Service Type: Outpatient Service (822) PRU: 51591 Certified Capacity: with Telepractice Designation
Program Name: Arms Acres Outpatient Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10666_ArmsAc.pdf
Certificate Number: 210811488 Amendment Effective: 02/23/2021 Anticipated Recert Review: 8/31/2021 Program Location: 1st Floor, F Wing, 75 Seminary Hill Road, Carmel, New York 10512 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 50798 Certified Capacity: 39 with Telepractice Designation [with the use of methadone] [Up to 22 of these beds may be used for the provision of Part 818 inpatient rehabilitation services as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11488_ArmsAc.pdf
Certificate Number: 240611619 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2024 Program Location: 1st Floor, 3584 Jerome Avenue, Bronx, New York 10467 Service Type: Outpatient Service (822) PRU: 52100 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11619_ArmsAc.pdf
Certificate Number: 210912074 Amendment Effective: 10/16/2019 Anticipated Recert Review: 9/30/2021 Program Location: 1st Floor, 21 Old Route 6, , Carmel, New York 10512 Service Type: Opioid Full Agonist Treatment Program (822) PRU: 53070 Certified Capacity: 200 with Telepractice Designation Capacity Lifted Program Name: Arms Acres Opioid Treatment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12074_ArmsAc.pdf
Arnot Health, Inc. as Sponsor Arnot Ogden Medical Center as Operator Provider Number: 82200 Mr. Jonathan Lawrence, President and CEO Telephone - (607)-737-4233 Administrative Office: 600 Roe Avenue, Elmira, NY 14905
Certificate Number: 200412197 Establishment Effective: 05/30/2019 Anticipated Recert Review: 4/30/2020 Program Location: 6th Floor, 555 St. Joseph's Boulevard, , Elmira, New York 14901 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53357 Certified Capacity: 20
Program Name: New Dawn Southern Tier Addiction Rehabilitation Services (STARS)
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12197_ArnotH.pdf
September 21, 2021 Page 18 of 225 Backstretch Employee Service Team of New York, Inc. Provider Number: 47560 Mr. Paul Ruchames LCSW, Executive Director Telephone - (516)-488-3434 Ext 103 Administrative Office: Belmont Park, Gate 6, Cottage 28B, 2150 Hempstead Turnpike, Elmont, NY 11003
Certificate Number: 200911723 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 9/30/2020 Program Location: Cottage 28B, Belmont Park, Gate 6, 2150 Hempstead Turnpike, Elmont, New York 11003 Service Type: Outpatient Service (822) PRU: 52547 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11723_Backst.pdf
Baden Street Settlement of Rochester, Inc. Provider Number: 16220 Mr. Ron Thomas, Executive Director Telephone - (585)-445-6718 Administrative Office: 152 Baden Street, Rochester, NY 14605
Certificate Number: 190910671 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 9/30/2019 Program Location: 1st and 2nd Floor, 585 Joseph Avenue, Rochester, New York 14605 Service Type: Outpatient Service (822) PRU: 130 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10671_BadenS.pdf
Behavioral Enhancement and Substance Abuse Medicine Treatment, PLLC Provider Number: 48360 Tomrul Tuzel M.D., CEO/Medical Director Telephone - (631)-392-4357 Administrative Office: Suite 17, 770 Grand Boulevard, Deer Park, NY 11729
Certificate Number: 220311797 Amendment Effective: 05/05/2021 Anticipated Recert Review: 3/31/2022 Program Location: Suite 17, 770 Grand Boulevard, , Deer Park, New York 11729 Service Type: Outpatient Service (822) PRU: 52688 Certified Capacity: 0 with Telepractice Designation
Program Name:
21 Technology Drive, East Setauket, NY 11733 Additional Location(s) At: 6-7 Middle Country Road, Middle Island, NY 11953 Additional Location(s) At: 33 Foster Avenue, Sayville, NY 11782 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11797_Behavi.pdf
Behavioral Health Services North, Inc. Provider Number: 12050 Mr. Mark A. Lukens, President/CEO Telephone - (518)-324-2177 Administrative Office: Suite 218, 22 U.S. Oval, Plattsburgh, NY 12903
September 21, 2021 Page 19 of 225 Certificate Number: 211012236 Amendment Effective: 08/10/2021 Anticipated Recert Review: 10/31/2021 Program Location: 25 Willowbrook Road, , Queensbury, New York 12804 Service Type: Outpatient Service (822) PRU: 53508 Certified Capacity: with Telepractice Designation
Program Name: The Center for Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12236_Behavi.pdf
Certificate Number: 211012237 Amendment Effective: 08/10/2021 Anticipated Recert Review: 10/31/2021 Program Location: Basement & 1st Floor, 340 Main Street, , Hudson Falls, New York 12839 Service Type: Outpatient Service (822) PRU: 53509 Certified Capacity: with Telepractice Designation
Program Name: The Center for Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12237_Behavi.pdf
Certificate Number: 211212251 Establishment Effective: 01/08/2021 Anticipated Recert Review: 12/31/2021 Program Location: 1st and 2nd Floors, 75 Oak Street, , Plattsburgh, New York 12901 Service Type: Residential Services (820) PRU: 53530 Certified Capacity: 20
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Twin Oaks
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12251_Behavi.pdf
BGR Services, Inc. d/b/a The PAC Program of Brooklyn Provider Number: 44840 Ms. Maria Mendez, Executive VP/COO Telephone - (212)-837-2013 Administrative Office: 7 Debevoise Street, Brooklyn, NY 11206
Certificate Number: 210811567 Amendment Effective: 05/15/2020 Anticipated Recert Review: 8/31/2021 Program Location: 2nd Floor, 7 Debevoise Street, Brooklyn, New York 11206 Service Type: Outpatient Service (822) PRU: 52021 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11567_BGRSer.pdf
Bikur Cholim, Inc. Provider Number: 20470 Mr. Aron Reiner, Executive Director Telephone - (845)-425-7877 Ext 123 Administrative Office: 25 Robert Pitt Drive, Monsey, NY 10952
Certificate Number: 240312018 Renewal OMH Host Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: Suite 101, 1st Floor, 25 Robert Pitt Drive, Monsey, New York 10952 Service Type: Outpatient Service (822) PRU: 52968 Certified Capacity: [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12018_BikurC.pdf
September 21, 2021 Page 20 of 225 Bleuler Psychotherapy Center, Inc. Provider Number: 15300 Steven Helfand Psy.D, Executive Director Telephone - (718)-275-6010 Administrative Office: 3rd Floor, 104-70 Queens Boulevard, Forest Hills, NY 11375
Certificate Number: 210211700 Amendment OMH Host Effective: 09/01/2020 Anticipated Recert Review: 2/28/2021 Program Location: 3rd Floor, 104-70 Queens Boulevard, , Forest Hills, New York 11375 Service Type: Outpatient Service (822) PRU: 52521 Certified Capacity: with Telepractice Designation
Program Name: Bleuler Chemical Dependency Recovery Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11700_Bleule.pdf
Bliss-Poston The Second Wind, Inc. Provider Number: 1823 Mr. John Bliss, Executive Director Telephone - (212)-481-1055 Administrative Office: Suite 403, 928 Broadway, New York, NY 10010
Certificate Number: 220110675 Amendment Effective: 08/31/2020 Anticipated Recert Review: 1/31/2022 Program Location: Suite 403, 4th Floor, 928 Broadway, New York, New York 10010 Service Type: Outpatient Service (822) PRU: 5111 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10675_BlissP.pdf
Bon Secours Community Hospital Provider Number: 81780 Mary Leahy M.D., Chief Executive Officer Telephone - (845)-368-5000 Administrative Office: 160 East Main Street, Port Jervis, NY 12771
Certificate Number: 210910242 Renewal Deemed Effective: 12/05/2018 Anticipated Recert Review: 9/7/2021 Program Location: 4th Floor, 160 East Main Street, Port Jervis, New York 12771 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 51051 Certified Capacity: 7 [with the use of methadone]
Program Name: New Directions
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10242_BonSec.pdf
Certificate Number: 210911363 Renewal Deemed Effective: 12/05/2018 Anticipated Recert Review: 9/7/2021 Program Location: 4th Floor, 160 East Main Street, Port Jervis, New York 12771 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51824 Certified Capacity: 15
Program Name: New Directions
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11363_BonSec.pdf
Bowery Residents' Committee, Inc. Provider Number: 50490 Mr. Muzzy Rosenblatt, CEO/President Telephone - (212)-803-5700 Administrative Office: 12th Floor, 131 West 25th Street, New York, NY 10001
September 21, 2021 Page 21 of 225 Certificate Number: 221110622 Amendment Effective: 07/31/2020 Anticipated Recert Review: 11/30/2022 Program Location: Rooms 1005, 1009, 1010, 1011, 1012, 1016, 1017, 1018, Conf rooms 1, 2 & 3, 10th Floor, 127 West 25th Street, , New York, New York 10001 Service Type: Outpatient Service (822) PRU: 50012 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10622_Bowery.pdf
Certificate Number: 201112117 Conditional Certificate Effective: 12/01/2019 Anticipated Recert Review: 11/30/2020 Program Location: 127 West 25th Street, New York, New York 10001 Service Type: Residential Services (820) PRU: 53160 Certified Capacity: 32
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12117_Bowery.pdf
Boys and Girls Harbor, Inc. Provider Number: 31050 Thomas Howard Ph.D., Executive Director Telephone - (212)-427-2244 Ext 582 Administrative Office: 1 East 104th Street, New York, NY 10029
Certificate Number: 200211967 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 2/29/2020 Program Location: 4th, 5th & 7th Floor, 1 East 104th Street, New York, New York 10029 Service Type: Prevention Counseling PRU: 90776 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11967_Boysan.pdf
Bridge Back to Life Center, Inc. Provider Number: 2050 Mr. Gary A. Butchen, Chief Executive Officer Telephone - (516)-520-6600 Administrative Office: Lower Level, 4271 Hempstead Turnpike, Bethpage, NY 11714
Certificate Number: 201110677 Amendment Effective: 04/22/2020 Anticipated Recert Review: 11/30/2020 Program Location: Basement, 1688 Victory Boulevard, Staten Island, New York 10314 Service Type: Outpatient Service (822) PRU: 6094 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10677_Bridge.pdf
Certificate Number: 211110678 Amendment Effective: 04/22/2020 Anticipated Recert Review: 11/30/2021 Program Location: Basement, 4271 Hempstead Turnpike, Bethpage, New York 11714 Service Type: Outpatient Service (822) PRU: 7139 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10678_Bridge.pdf
September 21, 2021 Page 22 of 225 Certificate Number: 210111254 Amendment Effective: 04/22/2020 Anticipated Recert Review: 1/31/2021 Program Location: 3rd Floor, 3044 Coney Island Avenue, Brooklyn, New York 11235 Service Type: Outpatient Service (822) PRU: 7356 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11254_Bridge.pdf
Certificate Number: 210111343 Amendment Effective: 04/22/2020 Anticipated Recert Review: 1/31/2021 Program Location: 10th Floor, 175 Remsen Street, Brooklyn, New York 11201 Service Type: Outpatient Service (822) PRU: 7180 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11343_Bridge.pdf
The Bridge, Inc. Provider Number: 18130 Ms. Susan Wiviott, Chief Executive Officer Telephone - (212)-663-3318 Administrative Office: 248 West 108th Street, New York, NY 10025
Certificate Number: 210511428 Amendment Effective: 10/07/2020 Anticipated Recert Review: 5/31/2021 Program Location: Cellar, 1st, 2nd, 3rd, 4th & 5th Floors, 248-250 West 108th Street, , New York , New York 10025 Service Type: Outpatient Service (822) PRU: 7371 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11428_Bridge.pdf
Bridging Access to Care, Inc. Provider Number: 31640 Ms. Nadine Akinyemi, Executive Director Telephone - (347)-505-5115 Administrative Office: 2261 Church Avenue, Brooklyn, NY 11226
Certificate Number: 220111255 Amendment Effective: 05/28/2020 Anticipated Recert Review: 1/31/2022 Program Location: 2261 Church Avenue, Brooklyn, New York 11226 Service Type: Outpatient Service (822) PRU: 7275 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11255_Bridgi.pdf
BronxCare Health System Provider Number: 85190 Mr. Miguel A. Fuentes Jr., President, Chief Telephone - (718)-901-8800 Administrative Office: Executive Officer Executive Suite, Main Floor, 1276 Fulton Avenue, Bronx, NY 10456
September 21, 2021 Page 23 of 225 Certificate Number: 220310288 Renewal Effective: 04/01/2019 Anticipated Recert Review: 3/31/2022 Program Location: Life Recovery Center, 5th Floor, 1285 Fulton Avenue, Bronx, New York 10456 Service Type: Community Residential (819) PRU: 50036 Certified Capacity: 22
Program Name: BronxCare Life Recovery Community Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10288_BronxC.pdf
Certificate Number: 210310445 Conditional Certificate Effective: 07/10/2020 Anticipated Recert Review: 3/31/2021 Program Location: 1276 Fulton Avenue, Bronx, New York 10456 Service Type: Opioid Treatment Program (822) PRU: 309 Certified Capacity: 600 with Telepractice Designation Capacity Lifted Program Name: BronxCare Opioid Treatment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10445_BronxC.pdf
Certificate Number: 200511409 Amendment Deemed Effective: 03/01/2018 Anticipated Recert Review: 5/6/2020 Program Location: 4th Floor, 1285 Fulton Avenue, Bronx, New York 10456 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51116 Certified Capacity: 25
Program Name: BronxCare Addictions Rehabilitation Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11409_BronxC.pdf
Certificate Number: 220711845 Conditional Certificate OASAS Host Effective: 08/01/2021 Anticipated Recert Review: 7/31/2022 Program Location: 1st and 2nd Floors, 1285 Fulton Avenue, Bronx, New York 10456 Service Type: Integrated Outpatient Services - PC PRU: Certified Capacity:
Program Name:
Service Type: Outpatient Service (822) PRU: 52764 Certified Capacity: with Telepractice Designation
Program Name: BronxCare Chemical Dependence Outpatient Treatment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11845_BronxC.pdf
Certificate Number: 200511846 Amendment Deemed Effective: 03/01/2018 Anticipated Recert Review: 5/6/2020 Program Location: Life Recovery Center, 3rd Floor, 1285 Fulton Avenue, Bronx, New York 10456 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 52763 Certified Capacity: 20 [Up to 10 of these beds (in Room #s 319, 321, 322, 324, 325, 327, 328, 330, 331, and 333) may be used for the provision of Part 818 inpatient rehabilitation services, as needed.]
Program Name: BronxCare Addictions Detoxification Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11846_BronxC.pdf
September 21, 2021 Page 24 of 225 Brookhaven Memorial Hospital Medical Center, Inc. d/b/a Long Island Community Hospital Provider Number: 85340 Mr. Richard T. Margulis, President and Chief Telephone - (631)-654-7177 Administrative Office: Executive Officer 101 Hospital Road, Patchogue, NY 11772
Certificate Number: 210810679 Amendment Effective: 09/29/2020 Anticipated Recert Review: 8/31/2021 Program Location: 550 Montauk Highway, , Shirley, New York 11967 Service Type: Outpatient Service (822) PRU: 50101 Certified Capacity: with Telepractice Designation
Program Name: Memorial Hospital Medical Center Outpatient Chemical Dependency Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10679_Brookh.pdf
Brooklyn Center for Psychotherapy, Inc. Provider Number: 32130 Ms. Kerri Kopelowitz, Executive Director Telephone - 718-622-2000 Administrative Office: 300 Flatbush Avenue, Brooklyn, NY 11217
Certificate Number: 230510680 Renewal OASAS Host Effective: 06/01/2021 Anticipated Recert Review: 5/31/2023 Program Location: 500/500A /502A Atlantic Avenue, Brooklyn, New York 11217 Service Type: Outpatient Service (822) PRU: 50337 Certified Capacity: 0 with Telepractice Designation
Program Name: New Directions Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10680_Brookl.pdf
The Brooklyn Hospital Center Provider Number: 27480 Gary Terrinoni M.D., President and CEO Telephone - (718)-250-8005 Administrative Office: 121 DeKalb Avenue, Brooklyn, NY 11201
Certificate Number: 220710510 Amendment Effective: 04/09/2020 Anticipated Recert Review: 7/31/2022 Program Location: B Building, Downtown Campus, 9th Floor, 121 DeKalb Avenue, Brooklyn, New York 11201 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 8033 Certified Capacity: 6 [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10510_Brookl.pdf
Brooks-TLC Hospital System, Inc. Provider Number: 49960 Ms. Mary E. LaRowe, President and CEO Telephone - (716)-363-7207 Administrative Office: 529 Central Avenue, Dunkirk, NY 14048
September 21, 2021 Page 25 of 225 Certificate Number: 210512141 Amendment Effective: 06/10/2020 Anticipated Recert Review: 5/31/2021 Program Location: 33 North Main Street, Cassadaga, New York 14718 Service Type: Outpatient Service (822) PRU: 53215 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12141_Brooks.pdf
Certificate Number: 210412142 Amendment Effective: 06/10/2020 Anticipated Recert Review: 4/30/2021 Program Location: 7020 Erie Road, Derby, New York 14047 Service Type: Outpatient Service (822) PRU: 53229 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12142_Brooks.pdf
Brownsville Community Development Corporation Provider Number: 45250 Mr. Harvey Lawrence, Chief Executive Telephone - (718)-345-5000 Ext 1123 Administrative Office: Officer/President 592 Rockaway Avenue, Brooklyn, NY 11212
Certificate Number: 211211588 Renewal Effective: 01/01/2019 Anticipated Recert Review: 12/31/2021 Program Location: 657-663 East 98th Street, Brooklyn, New York 11236 Service Type: Community Residential (819) PRU: 51330 Certified Capacity: 21
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11588_Browns.pdf
Brylin Hospitals, Inc. Provider Number: 81490 Mr. Eric D. Pleskow, Chief Executive Officer Telephone - (716)-886-8200 Ext 7601 Administrative Office: 1263 Delaware Avenue, Buffalo, NY 14209
Certificate Number: 201010687 Conditional Certificate Effective: 07/31/2020 Anticipated Recert Review: 10/31/2020 Program Location: 531 Farber Lakes Drive, Williamsville, New York 14221 Service Type: Outpatient Service (822) PRU: 50709 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10687_Brylin.pdf
Buffalo Beacon Corporation d/b/a Beacon Center Provider Number: 32812 Ms. Jacqueline West, Chief Executive Officer Telephone - (716)-602-9525 Administrative Office: 3354 Sheridan Drive, Amherst, NY 14226
September 21, 2021 Page 26 of 225 Certificate Number: 220910688 Amendment Effective: 01/03/2020 Anticipated Recert Review: 9/30/2022 Program Location: Suite 105, 295 Main Street, Buffalo, New York 14203 Service Type: Outpatient Service (822) PRU: 51708 Certified Capacity: with Telepractice Designtation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10688_Buffal.pdf
Certificate Number: 230910689 Renewal Effective: 10/01/2020 Anticipated Recert Review: 9/30/2023 Program Location: 3354 Sheridan Drive, Amherst, New York 14226 Service Type: Outpatient Service (822) PRU: 51048 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10689_Buffal.pdf
Certificate Number: 221210692 Amendment Effective: 01/03/2020 Anticipated Recert Review: 12/31/2022 Program Location: 36 East Avenue, Lockport, New York 14094 Service Type: Outpatient Service (822) PRU: 51818 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10692_Buffal.pdf
Certificate Number: 230211256 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/28/2023 Program Location: Room 106, 417 3rd Street, Niagara Falls, New York 14301 Service Type: Outpatient Service (822) PRU: 7330 Certified Capacity: With Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11256_Buffal.pdf
Certificate Number: 240311631 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: 1st and 2nd Floors, 210 South Main Street, Herkimer, New York 13350 Service Type: Outpatient Service (822) PRU: 52112 Certified Capacity: with Telepractice Designation
Program Name: Beacon Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11631_Buffal.pdf
Certificate Number: 210211754 Amendment Effective: 11/20/2020 Anticipated Recert Review: 2/28/2021 Program Location: 1508 Genesee Street, Utica, New York 13502 Service Type: Outpatient Service (822) PRU: 52584 Certified Capacity: with Telepractice Designation
Program Name:
September 21, 2021 Page 27 of 225 303 West Liberty Street, Rome, NY 13440 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11754_Buffal.pdf
Certificate Number: 230912042 Renewal Effective: 10/01/2020 Anticipated Recert Review: 9/30/2023 Program Location: 303 West Liberty Street, Rome, New York 13440 Service Type: Opioid Treatment Program (822) PRU: 53021 Certified Capacity: 150 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12042_Buffal.pdf
Certificate Number: 240112140 Renewal Effective: 02/01/2021 Anticipated Recert Review: 1/31/2024 Program Location: 201 King Street, Herkimer, New York 13350 Service Type: Residential Services (820) PRU: 53239 Certified Capacity: 15 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Albert O. Nichols House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12140_Buffal.pdf
Certificate Number: 210612231 Amendment Effective: 09/04/2020 Anticipated Recert Review: 6/30/2021 Program Location: 1st Floor, 1508 Genesee Street, , Utica, New York 13502 Service Type: Opioid Treatment Program (822) PRU: 53501 Certified Capacity: 150 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12231_Buffal.pdf
C.C.M.S. Provider Number: 19430 Mr. Emory X. Brooks, President and Chief Executive Telephone - (718)-802-0666 Administrative Office: Officer 2nd Floor, 25 Elm Place, Brooklyn, NY 11201
Certificate Number: 211110695 Renewal Effective: 12/01/2019 Anticipated Recert Review: 11/30/2021 Program Location: 1st Floor, 810 Classon Avenue, , Brooklyn, New York 11238 Service Type: Outpatient Service (822) PRU: 7277 Certified Capacity:
Program Name:
2nd Floor, 25 Elm Place, Brooklyn, NY 11201 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10695_CCMS.pdf
CAMBA, Inc. Provider Number: 31600 Ms. Joanne M. Oplustil, President and CEO Telephone - 718-287-2600 Administrative Office: 2nd Floor, 1720 Church Avenue, Brooklyn, NY 11226
September 21, 2021 Page 28 of 225 Certificate Number: 240411979 Renewal Effective: 05/01/2021 Anticipated Recert Review: 4/30/2024 Program Location: Administrative Site Only:, 2nd Floor, 1720 Church Avenue, Brooklyn, New York 11226 Service Type: Prevention Counseling PRU: 90812 Certified Capacity:
Program Name:
Public School 249, 2nd Floor, Room 202, 18 Marlborough Road, Brooklyn, NY 11226 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11979_CAMBAI.pdf
Camelot of Staten Island, Inc. Provider Number: 12030 Mr. Luke J. Nasta, Executive Director Telephone - (718)-356-5100 Administrative Office: Suite 4, 4442 Arthur Kill Road, Staten Island, NY 10309
Certificate Number: 210810696 Amendment Effective: 07/10/2020 Anticipated Recert Review: 8/31/2021 Program Location: 1268 Forest Avenue, Staten Island, New York 10302 Service Type: Outpatient Service (822) PRU: 1687 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10696_Camelo.pdf
Certificate Number: 210410697 Amendment Effective: 07/10/2020 Anticipated Recert Review: 4/30/2021 Program Location: Basement, 175-15 Rockaway Boulevard, Jamaica, New York 11434 Service Type: Outpatient Service (822) PRU: 5594 Certified Capacity: with Telepractice Designation
Program Name:
Basement, 521 West 49th Street, New York, NY 10019 Additional Location(s) At: 1st, 3rd & 4th Floors, 946 East 211th Street, Bronx, NY 10469 Additional Location(s) At: 2nd Floor, 730 Kelly Street, Bronx, NY 10455 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10697_Camelo.pdf
Certificate Number: 210212147 Conditional Certificate Effective: 03/01/2020 Anticipated Recert Review: 2/28/2021 Program Location: Seaview Hospital, 460H Brielle Avenue, Staten Island, New York 10314 Service Type: Residential Services (820) PRU: 53213 Certified Capacity: 45 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12147_Camelo.pdf
September 21, 2021 Page 29 of 225 Certificate Number: 220612267 Establishment Effective: 07/01/2021 Anticipated Recert Review: 6/30/2022 Program Location: 273 Heberton Avenue, , Staten Island, New York 10302 Service Type: Residential Services (820) PRU: 53541 Certified Capacity: 24 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12267_Camelo
Care Counseling Center, LLC Provider Number: 48850 Mr. Faruk Khwaja, Executive Director Telephone - (212)-602-1400 Administrative Office: 214 West 116th Street, New York, NY 10026
Certificate Number: 210811861 Amendment Effective: 07/01/2020 Anticipated Recert Review: 8/31/2021 Program Location: 214-216 West 116th Street, New York, New York 10026 Service Type: Outpatient Service (822) PRU: 52795 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11861_CareCo.pdf
Carnegie Hill Institute, Inc. Provider Number: 549 Ms. Anna Marie Karkus, Executive Director Telephone - (305)-772-2289 Administrative Office: Apt. 1BC, 116 East 92nd Street, New York, NY 10128
Certificate Number: 220510383 Amendment Effective: 06/05/2020 Anticipated Recert Review: 5/31/2022 Program Location: Basement & 1st Floor, 116 East 92nd Street, New York, New York 10128 Service Type: Opioid Treatment Program (822) PRU: 1472 Certified Capacity: 200 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10383_Carneg.pdf
Certificate Number: 220311257 Renewal Effective: 04/01/2019 Anticipated Recert Review: 3/31/2022 Program Location: Basement & 1st Floor, 116 East 92nd Street, New York, New York 10128 Service Type: Outpatient Service (822) PRU: 7335 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11257_Carneg.pdf
CASA-Trinity, Inc. Provider Number: 37130 Ms. Ann Domingos, CEO Telephone - (585)-991-5012 Administrative Office: 4612 Millennium Drive, Geneseo, NY 14454
September 21, 2021 Page 30 of 225 Certificate Number: 211010847 Renewal Effective: 11/01/2019 Anticipated Recert Review: 10/31/2021 Program Location: Wing B, 4612 Millennium Drive, Geneseo, New York 14454 Service Type: Outpatient Service (822) PRU: 50184 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10847_CASA-T.pdf
Certificate Number: 211210848 Renewal Effective: 01/01/2020 Anticipated Recert Review: 12/31/2021 Program Location: 45 Maple Street, Dansville, New York 14437 Service Type: Outpatient Service (822) PRU: 50186 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name: CASA-Trinity, Inc.
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10848_Counci.pdf d/b/a Trinity of Chemung County Certificate Number: 231111692 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: 2nd Floor, 150 Lake Street, Elmira, New York 14901 Service Type: Outpatient Service (822) PRU: 52231 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11692_CASATr.pdf
Certificate Number: 200112156 Amendment Effective: 01/02/2020 Anticipated Recert Review: 1/31/2020 Program Location: 45 Maple Street, , Dansville, New York 14437 Service Type: Residential Services (820) PRU: 53307 Certified Capacity: 26 with telepractice designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12156_CASATr.pdf
Certificate Number: 210212201 Establishment Effective: 03/12/2020 Anticipated Recert Review: 2/28/2021 Program Location: 1st Floor, 86 River Street, , Hornell, New York 14843 Service Type: Outpatient Service (822) PRU: 53387 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12201_CASA-T.pdf
September 21, 2021 Page 31 of 225 Certificate Number: 210212213 Establishment Effective: 03/12/2020 Anticipated Recert Review: 2/28/2021 Program Location: 7309 Seneca Road, Hornell, New York 14843 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 53386 Certified Capacity: 4 [up to 3 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12213_CASA-T.pdf
Certificate Number: 230612228 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2023 Program Location: 7309 Seneca Road, Hornell, New York 14843 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53491 Certified Capacity: 26 [up to 6 of these beds may be used for the provision of Part 816.7 medically supervised withdrawal and stabilization serivces, as needed
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12228_CASA-T.pdf
Catholic Charities Neighborhood Services, Inc. Provider Number: 40490 Ms Patricia Bowles, Senior Vice President/Chief Telephone - (718)-722-6146 Administrative Office: Program Officer 14th Floor, 191 Joralemon Street, Brooklyn, NY 11201
Certificate Number: 221110600 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2022 Program Location: Lower Level, 1623 Flatbush Avenue, , Brooklyn, New York 11210 Service Type: Outpatient Service (822) PRU: 51149 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10600_Cathol.pdf
Catholic Charities of Fulton and Montgomery Counties Provider Number: 12340 Ms. Mary A. Carpenter, Executive Director Telephone - (518)-762-8313 Ext 226 Administrative Office: Suite 100, 55 East Main Street, Johnstown, NY 12095
Certificate Number: 230112003 Renewal Effective: 02/01/2020 Anticipated Recert Review: 1/31/2023 Program Location: Suite 100, 55 East Main Street, Johnstown, New York 12095 Service Type: Prevention Counseling PRU: 90645 Certified Capacity:
Program Name: Catholic Charities of Fulton County
Oppenheim Ephratah St. Johnsville Elementary School, 6486 State Highway 29, St. Johnsville, NY 13452 Other Service Site(s) At: Edinburg Common School District, Prevention Counseling Office, 4 Johnson Road, Edinburg, NY 12134 Other Service Site(s) At: Wheelerville Union Free School District, 2417 State Highway 10, Caroga Lake, NY 12032 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12003_Cathol.pdf
September 21, 2021 Page 32 of 225 Certificate Number: 221212005 Renewal Effective: 01/01/2020 Anticipated Recert Review: 12/31/2022 Program Location: Building 2, 1 Kimball Street, Amsterdam, New York 12010 Service Type: Prevention Counseling PRU: 90659 Certified Capacity:
Program Name:
Fonda Fultonville High School, 112 Old Johnstown Road, Fonda, NY 12068 Other Service Site(s) At: Fort Plain Jr./Sr. High School, 1 West Street, Fort Plains, NY 13339 Other Service Site(s) At: East Hill School, 25 School District Road, Canajoharie, NY 13317 Other Service Site(s) At: Fonda Fultonville Central School, Cemetery Road, Fonda, NY 12068 Other Service Site(s) At: East High School, North Wing, 25 School District Road, Canajoharie, NY 13317 Other Service Site(s) At: Oppenheim Ephratah St. Johnsville Jr/Sr High School, 44 Center Street, St. Johnsville, NY 13452 Other Service Site(s) At: Fonda Fultonville Middle School, 112 Old Johnstown Road, Fonda, NY 12068 Other Service Site(s) At: Fonda Fultonville Elementary School, 112 Old Johnstown Road, Fonda, NY 12068 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12005_Cathol.pdf
Catholic Charities of Herkimer County Provider Number: 17000 Ms. Maureen Petrie, Executive Director Telephone - (315)-894-9917 Ext 222 Administrative Office: 61 West St, Ilion, NY 13357
Certificate Number: 211112002 Renewal Effective: 12/01/2018 Anticipated Recert Review: 11/30/2021 Program Location: Room 7, Basement Level, 61 West Street, Ilion, New York 13357 Service Type: Prevention Counseling PRU: 90649 Certified Capacity:
Program Name:
Frankfort/Schuyler Central School, Rooms 143B, 143D, 145 and 146, 605 Palmer Street, Frankfort, NY 13340 Other Service Site(s) At: Herkimer BOCES, 352 Gros Blvd Street, Herkimer, NY 13350 Other Service Site(s) At: Dolgeville Central School, Office Adj. to Room 12, 38 Slawson Street, Dolgeville, NY 13329 Other Service Site(s) At: Town of Webb School, 2nd Floor Office, 3002 Main Street, Old Forge, NY 13420 Other Service Site(s) At: Poland Central School, 1st Floor, Guidance Office, 74 Cold Brook Street, Poland, NY 13431 Other Service Site(s) At: Herkimer Central School District, 1st Floor, Office, 801 W. German Street, Herkimer, NY 13350 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12002_Cathol.pdf
September 21, 2021 Page 33 of 225 Catholic Charities of Orange, Sullivan & Ulster Provider Number: 45020 Ms. Shannon Kelly, Deputy CEO Telephone - (845)-294-5124 Ext 1002 Administrative Office: 27 Matthews Street, Goshen, NY 10924
Certificate Number: 210311577 Renewal Effective: 04/01/2019 Anticipated Recert Review: 3/31/2021 Program Location: 101 Carpenter Place, Monroe, New York 10950 Service Type: Outpatient Service (822) PRU: 52117 Certified Capacity: with Telepractice Designation
Program Name: Monroe Clinic OP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11577_Cathol.pdf
Certificate Number: 210311578 Renewal Effective: 08/19/2019 Anticipated Recert Review: 3/31/2021 Program Location: 305 North Street, Middletown, New York 10940 Service Type: Outpatient Service (822) PRU: 52116 Certified Capacity: with Telepractice Designation
Program Name: Middletown Clinic OP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11578_Cathol.pdf
Certificate Number: 230411579 Amendment Effective: 08/31/2021 Anticipated Recert Review: 4/30/2023 Program Location: 1st Floor, 27 Matthews Street, Goshen, New York 10924 Service Type: Outpatient Service (822) PRU: 52115 Certified Capacity: with Telepractice Designation
Program Name: Goshen Clinic OP
South Wing, 4 Harriman Drive, Goshen, NY 10924 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11579_Cathol.pdf
Certificate Number: 210311580 Renewal Effective: 04/01/2019 Anticipated Recert Review: 3/31/2021 Program Location: Ground Floor, 280 Broadway, , Newburgh, New York 12550 Service Type: Outpatient Service (822) PRU: 52122 Certified Capacity: with Telepractice Designation
Program Name: Newburgh Clinic OP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11580_Cathol.pdf
Certificate Number: 211111688 Amendment Effective: 08/31/2021 Anticipated Recert Review: 11/30/2021 Program Location: 1st Floor, 17-19 Sussex Street, Port Jervis, New York 12771 Service Type: Outpatient Service (822) PRU: 52217 Certified Capacity: with Telepractice Designation
Program Name: Port Jervis Clinic OP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11688_Cathol.pdf
September 21, 2021 Page 34 of 225 Certificate Number: 230411720 Amendment Effective: 08/31/2021 Anticipated Recert Review: 4/30/2023 Program Location: 8 Scofield Street, Walden, New York 12586 Service Type: Outpatient Service (822) PRU: 52539 Certified Capacity: with Telepractice Designation
Program Name: Walden Clinic OP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11720_Cathol.pdf
Certificate Number: 210111866 Conditional Certificate Effective: 02/01/2020 Anticipated Recert Review: 1/31/2021 Program Location: 396 Broadway, Monticello, New York 12701 Service Type: Outpatient Service (822) PRU: 52808 Certified Capacity: with Telepractice Designation
Program Name: Monticello Clinic OP/Day Rehab OP-R Service Type: Outpatient Rehabilitation Service (822) PRU: 52812 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11866_Cathol.pdf
Certificate Number: 190711867 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 7/31/2019 Program Location: 16 Jones Street, Monticello, New York 12701 Service Type: Supportive Living (819) PRU: 52813 Certified Capacity: 7
Program Name: Monticello SMART SL
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11867_Cathol.pdf
Certificate Number: 190711868 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 7/31/2019 Program Location: 1st & 2nd Floors, 17 Hamilton Avenue, Monticello, New York 12701 Service Type: Community Residential (819) PRU: 52810 Certified Capacity: 30
Program Name: Monticello CR
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11868_Cathol.pdf
Certificate Number: 230311869 Amendment Effective: 08/31/2021 Anticipated Recert Review: 3/31/2023 Program Location: 1st & 2nd Floors, 17 Hamilton Avenue, Monticello, New York 12701 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 52806 Certified Capacity: 6
Program Name: Monticello MSW IP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11869_Cathol.pdf
Certificate Number: 181211870 Conditional Certificate Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1st & 2nd Floors, 17 Hamilton Avenue, Monticello, New York 12701 Service Type: Medically Monitored Withdrawal & Stabilization Services (816.9) PRU: 52807 Certified Capacity: 10
Program Name: Monticello MMW IP
September 21, 2021 Page 35 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11870_Cathol.pdf
Catholic Charities of the Diocese of Rochester d/b/a Catholic Charities Steuben/Livingston Provider Number: 44050 Tabitha J. Brewster Ph.D., Chief Executive Director Telephone - (607)-776-8085 Administrative Office: 23 Liberty Street, Bath, NY 14810
Certificate Number: 230212053 Amendment Effective: 03/02/2021 Anticipated Recert Review: 2/28/2023 Program Location: Administrative Site Only:, 1st and 2nd Floors, 8 East Morris Street, Bath, New York 14810 Service Type: Prevention Counseling PRU: 90722 Certified Capacity:
Program Name:
Haverling Junior Senior High School, Room 170, 25 Ellas Avenue, Bath, NY 14810 Other Service Site(s) At: Hammondsport High School, Room 128A, Main Street, Hammondsport, NY 14840 Other Service Site(s) At: Campbell-Savona Elementary School, Room Adj. to Room 113, 64 East Lamoka Avenue, Savona, NY 14879 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12053_Cathol.pdf
Certificate Number: 240212188 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/29/2024 Program Location: Basement, 1st & 2nd Floors, 130 Rumsey Street, , Bath, New York 14810 Service Type: Residential Services (820) PRU: 53344 Certified Capacity: 18
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12188_Cathol.pdf
Certificate Number: 200812189 Establishment Effective: 09/06/2019 Anticipated Recert Review: 8/31/2020 Program Location: Administrative Site:, 23 Liberty Street, , Bath, New York 14810 Service Type: Residential Services (820) PRU: 53343 Certified Capacity: 18
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12189_Cathol.pdf
Catholic Charities of the Diocese of Rochester d/b/a Catholic Family Center Provider Number: 20250 Ms. Marlene Bessette, President and Chief Telephone - (585)-546-7220 Ext 7153 Administrative Office: Executive Officer Floor #s 1 - 7, 79 North Clinton Avenue, Rochester, NY 14604
September 21, 2021 Page 36 of 225 Certificate Number: 210510700 Amendment OMH Host Effective: 03/03/2020 Anticipated Recert Review: 5/31/2021 Program Location: Floor #s 1 - 7, 79 North Clinton Avenue, Rochester, New York 14604 Service Type: Outpatient Service (822) PRU: 1191 Certified Capacity: 0 with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51933 Certified Capacity: with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10700_Cathol.pdf
Certificate Number: 181211673 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1st & 2nd Flrs, Basement, 380 Barrington Street, Rochester, New York 14607 Service Type: Community Residential (819) PRU: 52207 Certified Capacity: 11
Program Name: Barrington Street Community Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11673_Cathol.pdf
Certificate Number: 181211674 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1st & 2nd Flrs, Basement, 184 Alexander Street, Rochester, New York 14607 Service Type: Community Residential (819) PRU: 52208 Certified Capacity: 16
Program Name: Alexander Street Community Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11674_Cathol.pdf
Certificate Number: 181211675 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 3rd Floor, 79 North Clinton Avenue, Rochester, New York 14604 Service Type: Supportive Living (819) PRU: 52210 Certified Capacity: 24
Program Name: Restart Supportive Living Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11675_Cathol.pdf
Certificate Number: 190611676 Amendment Effective: 03/01/2019 Anticipated Recert Review: 6/30/2019 Program Location: 24 Jones Avenue, , Rochester, New York 14608 Service Type: Community Residential (819) PRU: 52209 Certified Capacity: 24
Program Name: Jones Avenue Community Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11676_Cathol.pdf
September 21, 2021 Page 37 of 225 Certificate Number: 201111995 Renewal Effective: 12/01/2018 Anticipated Recert Review: 11/30/2020 Program Location: Administrative Site Only:, 79 N. Clinton Avenue, Rochester, New York 14604 Service Type: Prevention Counseling PRU: 90651 Certified Capacity:
Program Name:
Edison Technical High School, 655 Colfax Street, Rochester, NY 14606 Other Service Site(s) At: Children's School of Rochester, 1st Floor, Room #95, 595 Upper Falls Boulevard, Rochester, NY 14605 Other Service Site(s) At: Merton Williams Middle School, 200 School Lane, Hilton, NY 14468 Other Service Site(s) At: Bishop Kearney High School, 125 Kings Highway South, Rochester, NY 14617 Other Service Site(s) At: Hilton High School, 400 East Avenue, Hilton, NY 14468 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11995_Cathol.pdf
Certificate Number: 181212060 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 997 St. Paul Street, Rochester, New York 14605 Service Type: Residential Services (820) PRU: 53040 Certified Capacity: 17 [2 of these beds may be used temporarily for adults] - with Telepractice Designation and up to 5 beds for children Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Liberty Manor
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12060_Cathol.pdf
Certificate Number: 190812061 Amendment Effective: 01/24/2019 Anticipated Recert Review: 8/31/2019 Program Location: Basement, 1st & 2nd Floors, 55 Troup Street, Rochester, New York 14608 Service Type: Residential Services (820) PRU: 53038 Certified Capacity: 30 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Freedom House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12061_Cathol.pdf
Certificate Number: 211212062 Renewal Effective: 01/01/2020 Anticipated Recert Review: 12/31/2021 Program Location: (Counseling), 407 East Union Street, 110 South Clinton Street, 1st & 2nd Floors, (Residence), Newark, New York 14513 Service Type: Residential Services (820) PRU: 53039 Certified Capacity: 20 [2 of these beds may be used temporarily for adults] - with Telepractice Designation and up to 7 beds for children Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Hannick Hall
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12062_Cathol.pdf
September 21, 2021 Page 38 of 225 Catholic Charities of the Diocese of Rockville Centre Provider Number: 20580 Ms. Laura A. Cassell, Chief Executive Telephone - (516)-733-7000 Administrative Office: Officer/Executive Director 90 Cherry Lane, Hicksville, NY 11801
Certificate Number: 210310585 Amendment Effective: 09/21/2020 Anticipated Recert Review: 3/31/2021 Program Location: 155 Indian Head Road, Commack, New York 11725 Service Type: Outpatient Service (822) PRU: 50121 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10585_Cathol.pdf
Certificate Number: 201010586 Amendment Effective: 09/21/2020 Anticipated Recert Review: 10/31/2020 Program Location: St. Rosalie's Church, Lower Level, 31 East Montauk Highway, , Hampton Bays, New York 11946 Service Type: Outpatient Service (822) PRU: 50125 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10586_Cathol.pdf
Certificate Number: 210212049 Conditional Certificate Effective: 03/01/2020 Anticipated Recert Review: 2/28/2021 Program Location: 30-C Carlough Road, Bohemia, New York 11716 Service Type: Residential Services (820) PRU: 53205 Certified Capacity: 35
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Talbot House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12049_Cathol.pdf
Catholic Charities of the Diocese of Syracuse Provider Number: 50760 Ms. Marie Walsh, Executive Director Telephone - (607)-756-5992 Ext 202 Administrative Office: 10 Kennedy Parkway, Cortland, NY 13045
Certificate Number: 190810208 Amendment Effective: 05/17/2019 Anticipated Recert Review: 8/31/2019 Program Location: 29 Charles Street, Cortland, New York 13045 Service Type: Supportive Living (819) PRU: 51514 Certified Capacity: 9
Program Name: Recovery Apartment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10208_Cathol.pdf
Certificate Number: 181211655 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 29 Charles Street, Cortland, New York 13045 Service Type: Community Residential (819) PRU: 51308 Certified Capacity: 14
Program Name: Catholic Charities The Charles Street Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11655_Cathol.pdf
September 21, 2021 Page 39 of 225 Catholic Charities of the Roman Catholic Diocese of Syracuse, N.Y. d/b/a Catholic Charities of Utica/Rome Provider Number: 20560 Ms. Denise L. Cavanaugh, Executive Director Telephone - (315)-724-2158 Ext 7000 Administrative Office: Administrative Office, 1408 Genesee Street, Utica, NY 13502
Certificate Number: 181210056 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1616 Genesee Street, Utica, New York 13502 Service Type: Community Residential (819) PRU: 51784 Certified Capacity: 16
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10056_Cathol.pdf
Certificate Number: 200710057 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 7/31/2020 Program Location: Basement, 1st & 2nd Flrs, 1505 Whitesboro Street, Utica, New York 13502 Service Type: Community Residential (819) PRU: 50681 Certified Capacity: 16
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10057_Cathol.pdf
Catholic Health System, Inc. as Sponsor Mount St. Mary's Hospital of Niagara Falls as Operator Provider Number: 81790 Mr. Charles Urlaub, Chief Executive Officer Telephone - (716)-298-2017 Administrative Office: Mount St. Mary's Hospital of Niagara Falls as Operator, 5300 Military Road, Lewiston, NY 14092
Certificate Number: 210211890 Amendment Deemed Effective: 10/03/2018 Anticipated Recert Review: 2/23/2021 Program Location: 3rd and 4th Floors, 5300 Military Road, Lewiston, New York 14092 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 52859 Certified Capacity: 69
Program Name: Clearview Treatment Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11890_Cathol.pdf
Cazenovia Recovery Systems, Inc. Provider Number: 38170 Ms. Suzanne Bissonette J.D., Chief Executive Officer Telephone - (716)-852-4331 Ext 203 Administrative Office: Suite 417, 2495 Main Street, Buffalo, NY 14214
Certificate Number: 191011823 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 10/31/2019 Program Location: 200 Albany Street, , Buffalo, New York 14213 Service Type: Community Residential (819) PRU: 52726 Certified Capacity: 19
Program Name: Casa Di Vita by Caz Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11823_Cazeno.pdf
Certificate Number: 181211860 Amendment Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Administrative Site Only:, 2671 Main Street, , Buffalo, New York 14214 Service Type: Supportive Living (819) PRU: 50806 Certified Capacity: 138
Program Name:
September 21, 2021 Page 40 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11860_Cazeno.pdf
Certificate Number: 181211889 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 923 Sycamore Street, Buffalo, New York 14212 Service Type: Community Residential (819) PRU: 52853 Certified Capacity: 24
Program Name: Unity House by Caz Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11889_Cazeno.pdf
Certificate Number: 190511952 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 5/31/2019 Program Location: 7397 Lake Road, Appleton, New York 14008 Service Type: Community Residential (819) PRU: 52889 Certified Capacity: 17
Program Name: Somerset House by Caz Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11952_Cazeno.pdf
Certificate Number: 190511953 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 5/31/2019 Program Location: Basement, 1st, 2nd & 3rd Floors, 431 Memorial Parkway, , Niagara Falls, New York 14303 Service Type: Community Residential (819) PRU: 52886 Certified Capacity: 17
Program Name: Sundram Manor by Caz Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11953_Cazeno.pdf
Certificate Number: 190511961 Amendment Effective: 01/08/2018 Anticipated Recert Review: 5/31/2019 Program Location: Administrative Site Only:, 1522 Main Street, , Niagara Falls, New York 14305 Service Type: Supportive Living (819) PRU: 52932 Certified Capacity: 15 and up to 3 beds for children Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11961_Cazeno.pdf
Certificate Number: 200512050 Amendment Effective: 08/22/2019 Anticipated Recert Review: 5/31/2020 Program Location: 1st & 2nd Floors, 486 North Legion Drive, , Buffalo, New York 14210 Service Type: Residential Services (820) PRU: 53077 Certified Capacity: 23 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Cazenovia Manor by Caz Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12050_Cazeno.pdf
Certificate Number: 181212051 Amendment Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 5586 Niagara Street Extension, Lockport, New York 14094 Service Type: Residential Services (820) PRU: 53076 Certified Capacity: 16 with Telepractice Designation and up to 12 beds for children Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Madonna House by Caz Recovery
September 21, 2021 Page 41 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12051_Cazeno.pdf
Certificate Number: 190912124 Amendment Effective: 08/22/2019 Anticipated Recert Review: 9/30/2019 Program Location: 1st Floor, 9126 Sandrock Road & 9136 Sandrock Road, , Eden, New York 14057 Service Type: Residential Services (820) PRU: 53246 Certified Capacity: 21 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Turning Point House by Caz Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12124_Cazeno.pdf
Center for Community Alternatives, Inc. Provider Number: 2136 Mr. David Condliffe, Executive Director Telephone - (315)-546-4365 Administrative Office: Suite 701, 25 Chapel Street, Brooklyn, NY 11201
Certificate Number: 231210704 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2023 Program Location: 7th Floor, 25 Chapel Street, Brooklyn, New York 11201 Service Type: Outpatient Service (822) PRU: 6520 Certified Capacity: with Telepractice Designation
Program Name: Crossroads
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10704_Center.pdf
Center for Comprehensive Health Practice, Inc. Provider Number: 10030 Ms. Ann M. Mendelsohn, Chief Executive Officer Telephone - (212)-360-7481 Administrative Office: 12th Floor, 1900 2nd Avenue, New York, NY 10029
Certificate Number: 211110705 Amendment Effective: 06/26/2021 Anticipated Recert Review: 11/30/2021 Program Location: 12th Floor, 1900 2nd Avenue, , New York, New York 10029 Service Type: Outpatient Service (822) PRU: 7053 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10705_Center.pdf
Certificate Number: 210311670 Amendment Effective: 07/10/2020 Anticipated Recert Review: 3/31/2021 Program Location: 12th Floor, 1900 2nd Avenue, , New York, New York 10029 Service Type: Opioid Treatment Program (822) PRU: 3553 Certified Capacity: 444 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11670_Center.pdf
The Center for Rapid Recovery, Inc. Provider Number: 26730 Renee D. Charles Ph.D., President & Chief Telephone - (516)-292-6449 Administrative Office: Executive Officer 312 Greenwich Street, Hempstead, NY 11550
September 21, 2021 Page 42 of 225 Certificate Number: 200811050 Conditional Certificate Effective: 09/01/2019 Anticipated Recert Review: 8/31/2020 Program Location: 1st Floor, 312 Greenwich Street, Hempstead, New York 11550 Service Type: Outpatient Service (822) PRU: 7252 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11050_Center.pdf
The Center for Youth Services, Inc. Provider Number: 37050 Elaine Spaull Ph.D., Executive Director Telephone - (585)-473-2464 Administrative Office: 905 Monroe Avenue, Rochester, NY 14620
Certificate Number: 220311987 Renewal Effective: 04/01/2019 Anticipated Recert Review: 3/31/2022 Program Location: 1st Floor, 901-905 Monroe Avenue, Rochester, New York 14620 Service Type: Prevention Counseling PRU: 90698 Certified Capacity:
Program Name:
James Monroe High School, 2nd Floor, Room 202, 164 Alexander Street, Rochester, NY 14607 Other Service Site(s) At: East High School, 1st Floor, Room B-130, 1801 East Main Street, Rochester, NY 14609 Other Service Site(s) At: School of the Arts (SOTA), 3rd Floor, Room 432, 45 Prince Street, Rochester, NY 14607 Other Service Site(s) At: Joseph C. Wilson Magnet High School Commencement Academy, 501 Genesee Street, Rochester, NY 14611 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11987_Center.pdf
Central Nassau Guidance and Counseling Services, Inc. Provider Number: 50710 Mr. Jeffrey Friedman, Chief Executive Officer Telephone - (516)-822-6111 Administrative Office: 950 South Oyster Bay Road, Hicksville, NY 11801
Certificate Number: 230910706 Renewal OMH Host Effective: 10/01/2020 Anticipated Recert Review: 9/30/2023 Program Location: 950 South Oyster Bay Road, Hicksville, New York 11801 Service Type: Outpatient Service (822) PRU: 771 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10706_Centra.pdf
Central Park Recovery, LLC Provider Number: 51520 Ms Nicole Intervallo, Chief Executive Officer Telephone - (914)-619-5242 Administrative Office: 2176 Central Park Avenue, Yonkers, NY 10710
September 21, 2021 Page 43 of 225 Certificate Number: 220612241 Establishment Effective: 07/19/2021 Anticipated Recert Review: 6/30/2022 Program Location: 2176 Central Park Avenue, , Yonkers, New York 10710 Service Type: Outpatient Service (822) PRU: 53514 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 53564 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Champlain Valley Family Center for Drug Treatment and Youth Services, Inc. Provider Number: 1065 Ms. Constance Wille, Executive Director Telephone - (518)-561-8480 Administrative Office: 20 Ampersand Drive, Plattsburgh, NY 12901
Certificate Number: 220110710 Amendment Effective: 05/11/2020 Anticipated Recert Review: 1/31/2022 Program Location: 20 Ampersand Drive, Plattsburgh, New York 12901 Service Type: Outpatient Service (822) PRU: 3101 Certified Capacity: with Telepractice Designation
Program Name:
Hawkins Hall, Plattsburgh State University, Basement, Room 053E, 55 Beekman Street, Plattsburgh, NY 12901 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10710_Champl.pdf
Certificate Number: 210212015 Renewal Effective: 03/01/2019 Anticipated Recert Review: 2/28/2021 Program Location: 20 Ampersand Drive, Plattsburgh, New York 12901 Service Type: Prevention Counseling PRU: 90620 Certified Capacity:
Program Name:
Plattsburgh High School, Health Office, Room 406, One Clifford Drive, Plattsburgh, NY 12901 Other Service Site(s) At: Saranac Central School, 60 Picketts Corners Road, Saranac, NY 12981 Other Service Site(s) At: Northeastern Clinton Middle/High School, High School, 1st Floor, Guidance Office, 103 Route 276, Champlain, NY 12919 Other Service Site(s) At: Peru Center Jr/Sr High School, Room 1C, 17 School Street, 1st Floor, Peru, NY 12972 Other Service Site(s) At: Plattsburgh Middle School, Study, B-1, 15 Broad Street, Plattsburgh, NY 12901 Other Service Site(s) At: Beekmantown Central School District, Counseling Offices, 1st & 2nd Floors, 37 Eagle Way, West Chazy, NY 12992 Other Service Site(s) At: Northern Adirondack Central School District, Room BC-2, 5586 State Route 11, Ellenburg Depot, NY 12935 Other Service Site(s) At:
September 21, 2021 Page 44 of 225 AuSable Valley Central Middle School, Main Floor, Guidance Office - Rm 132, 1273 Route 9N, Keeseville, NY 12924 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12015_Champl.pdf
Certificate Number: 240412138 Renewal Effective: 05/01/2021 Anticipated Recert Review: 4/30/2024 Program Location: 516 Norrisville Road , Schuyler Falls, New York 12985 Service Type: Residential Services (820) PRU: 53247 Certified Capacity: 16
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Champlain Valley Family Center Recovery Campus
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12138_Champl.pdf
Charles Evans Center, Inc. Provider Number: 49140 Mr. James R. Dolan Jr., Executive Director Telephone - (516)-622-8888 Ext 225 Administrative Office: 857 South Oyster Bay Road, Bethpage, NY 11714
Certificate Number: 201112218 Amendment Effective: 10/20/2020 Anticipated Recert Review: 11/30/2020 Program Location: 113 Glen Cove Avenue, , Glen Cove, New York 11542 Service Type: Outpatient Service (822) PRU: 53342 Certified Capacity: with Telepractice Designation
Program Name: Charles Evans Center at Glen Cove
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12218_Charle.pdf
Chautauqua County Department of Mental Health Provider Number: 70360 Ms. Patricia A. Brinkman M.S., M.B.A., Director of Telephone - (716)-753-4104 Administrative Office: Community Mental Hygiene Services Hall R Clothier Bldg., 1st Floor, 2 Academy Street, Mayville, NY 14757
Certificate Number: 210610711 Amendment OMH Host Effective: 10/13/2020 Anticipated Recert Review: 6/30/2021 Program Location: City Hall, 5th Floor, 200 East Third Street, Jamestown, New York 14701 Service Type: Outpatient Service (822) PRU: 50702 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10711_Chauta.pdf
Certificate Number: 210610712 Amendment OMH Host Effective: 10/13/2020 Anticipated Recert Review: 6/30/2021 Program Location: 2nd Floor, 319 Central Avenue, Dunkirk, New York 14048 Service Type: Outpatient Service (822) PRU: 50703 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10712_Chauta.pdf
September 21, 2021 Page 45 of 225 Chenango County Community Services Board Provider Number: 70010 Ms. Ruth Roberts, Director Telephone - (607)-337-1604 Administrative Office: County Office Building, Suite 42, 5 Court Street, Norwich, NY 13815
Certificate Number: 231010713 Renewal Effective: 11/01/2020 Anticipated Recert Review: 10/31/2023 Program Location: Suite 42, 5 Court Street, Norwich, New York 13815 Service Type: Outpatient Service (822) PRU: 472 Certified Capacity: with Telepractice Designation
Program Name: Chenango County Behavioral Health Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10713_Chenan.pdf
Child & Family Guidance Center Addiction Services, Inc. Provider Number: 16230 Mr. Christopher Dennehy, Executive Director Telephone - (845)-594-4239 Administrative Office: 106 Vineyard Avenue, Highland, NY 12528
Certificate Number: 221010715 Amendment Effective: 12/02/2020 Anticipated Recert Review: 10/31/2022 Program Location: 106 Vineyard Avenue and 102 Vineyard Avenue (1st & 2nd Floors), Highland, New York 12528 Service Type: Outpatient Service (822) PRU: 51463 Certified Capacity: with Telepractice Designation
Program Name:
Step One, 500 Aaron Court, Kingston, NY 12401 Additional Location(s) At: 1st and 2nd Floors, 83 North Main Street, Ellenville, NY 12428 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10715_ChildF.pdf
Certificate Number: 221011653 Renewal Effective: 11/01/2019 Anticipated Recert Review: 10/31/2022 Program Location: Northeast Center for Rehab and Traumatic Brain Injury, 1st Floor, Rooms 322 & 507, 300 Grant Avenue, 2nd Floor, Rooms 128, 219, 333, & 704, Lake Katrine, New York 12449 Service Type: Outpatient Service (822) PRU: 52156 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11653_ChildF.pdf
The Child Center of NY, Inc. Provider Number: 18000 Ms. Traci Donnelly, CEO and Executive Director Telephone - (718)-651-7770 Administrative Office: 6th Floor, 118-35 Queens Boulevard, Forest Hills, NY 11375
Certificate Number: 220510953 Amendment OMH Host Effective: 07/29/2021 Anticipated Recert Review: 5/31/2022 Program Location: 115-15 Sutphin Boulevard, Jamaica, New York 11434 Service Type: Outpatient Service (822) PRU: 6308 Certified Capacity:
Program Name: Jamaica Family Center-CD-OP
2nd Floor, 163-18 Jamaica Avenue, Jamaica, NY 11432 Additional Location(s) At:
September 21, 2021 Page 46 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10953_ChildC.pdf
Certificate Number: 220511277 Renewal OMH Host Effective: 06/01/2019 Anticipated Recert Review: 5/31/2022 Program Location: 140-15B Sanford Avenue, Flushing, New York 11355 Service Type: Outpatient Service (822) PRU: 51686 Certified Capacity:
Program Name:
81-14 Queens Boulevard, Elmhurst, NY 11373 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11277_ChildC.pdf
The Children's Aid Society Provider Number: 20660 Ms. Phoebe C. Boyer, President and CEO Telephone - (212)-949-4800 Administrative Office: 117 W 124th Street, New York, NY 10027
Certificate Number: 201111973 Amendment Effective: 04/22/2020 Anticipated Recert Review: 11/30/2020 Program Location: Basement & 1st Floor, New York, New York 10026-1904, 14-32 West 118th Street, Prevention Records at:, 117 West 124th Street, New York, New York 10027 Service Type: Prevention Counseling PRU: 90763 Certified Capacity:
Program Name:
Lexington Academy PS 72, 408B, 131 East 104th Street, New York, NY 10029 Other Service Site(s) At: Opportunity Charter School, 4th Floor, 240 West 113th Street, New York, NY 10026 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11973_TheChi.pdf
The Children's Village, Inc. Provider Number: 14690 Jeremy Kohomban Ph.D., President/CEO Telephone - (914)-693-0600 Ext 1201 Administrative Office: One Echo Hill, Dobbs Ferry, NY 10522
Certificate Number: 200612143 Conditional Certificate Effective: 01/01/2020 Anticipated Recert Review: 6/30/2020 Program Location: 1 Echo Hills, , Dobbs Ferry, New York 10522 Service Type: Outpatient Service (822) PRU: 53242 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12143_Childr.pdf
Citizen Advocates, Inc. d/b/a North Star Industries Provider Number: 40410 Mr. Reid Anthony, CEO Telephone - (518)-483-1251 Administrative Office: 125 Finney Boulevard, P.O. Box 608, Malone, NY 12953
Certificate Number: 211010717 Amendment/Renewal OMH Host Effective: 07/01/2018 Anticipated Recert Review: 10/31/2021 Program Location: 31 Sixth Street, Malone, New York 12953 Service Type: Outpatient Service (822) PRU: 5048 Certified Capacity: [with ancillary withdrawal services]
Program Name:
September 21, 2021 Page 47 of 225 Lake Pleasant Central School - Lane Emporium, NYS Route 30 at Elm Lake Road, Speculator, NY 12164 Additional Location(s) At: 1st Floor, 70 Edgewood Road, Saranac Lake, NY 12983 Additional Location(s) At: 143 White Birch Road, Indian Lake, NY 12842 Additional Location(s) At: 7 Stetson Road, Tupper Lake, NY 12986 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10717_Citize.pdf
Certificate Number: 210312004 Renewal Effective: 04/01/2019 Anticipated Recert Review: 3/31/2021 Program Location: 31 Sixth Street, Malone, New York 12953 Service Type: Prevention Counseling PRU: 90719 Certified Capacity:
Program Name:
St. Regis Falls Central School, Room B121A, 92 North Main Street, St. Regis Falls, NY 12980 Other Service Site(s) At: Tupper Lake Central School, Rooms A207 & B107, 25 Chaney Avenue, Tupper Lake, NY 12986 Other Service Site(s) At: 43 River Street, Chateaugay, NY 12920 Other Service Site(s) At: Malone Middle School, Room 419, 15 Francis Street, Malone, NY 12953 Other Service Site(s) At: Malone High School (Franklin Academy), Room 118, 42 Huskie Lane, Malone, NY 12953 Other Service Site(s) At: Brushton-Moira Central School, Rooms D-10 & D-24, 758 County Route 7, Brushton, NY 12916 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12004_Citize.pdf
City of White Plains Youth Bureau Provider Number: 29210 Mr. Frank Williams Jr., Executive Director Telephone - (914)-422-1378 Ext 6702 Administrative Office: 11 Amherst Place, White Plains, NY 10601
Certificate Number: 210212027 Renewal Effective: 03/01/2018 Anticipated Recert Review: 2/28/2021 Program Location: 11 Amherst Place, White Plains, New York 10601 Service Type: Prevention Counseling PRU: 90664 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12027_Cityof.pdf
The Clifton Springs Sanitarium Company d/b/a Clifton Springs Hospital & Clinic Provider Number: 85490 Dustin Riccio, President, Eastern Region Telephone - (315)-332-2298 Administrative Office: 2 Coulter Road, Clifton Springs, NY 14432
September 21, 2021 Page 48 of 225 Certificate Number: 200711879 Renewal Effective: 08/01/2018 Anticipated Recert Review: 7/31/2020 Program Location: Woodbury Building, 3rd Floor, 2 Coulter Road, Clifton Springs, New York 14432 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 52847 Certified Capacity: 30 with Telepractice Designation
Program Name: The Inpatient Addiction Recovery Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11879_Clifto.pdf
Certificate Number: 211211880 Amendment OMH Host Effective: 09/10/2020 Anticipated Recert Review: 12/31/2021 Program Location: 1st Floor, 2 Coulter Road, , Clifton Springs, New York 14432 Service Type: Outpatient Service (822) PRU: 52846 Certified Capacity: with Telepractice Designation
Program Name:
1st Floor, 35 North Street, Canandaigua, NY 14424 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11880_Clifto.pdf
Clinton County Community Services Board Provider Number: 70020 Ms. Richelle Gregory, Director of Community Telephone - (518)-565-4060 Administrative Office: Services Suite 1500, 130 Arizona Avenue, Plattsburgh, NY 12903
Certificate Number: 211110723 Amendment OMH Host Effective: 10/13/2020 Anticipated Recert Review: 11/30/2021 Program Location: 130 Arizona Avenue, Plattsburgh, New York 12903 Service Type: Outpatient Service (822) PRU: 50757 Certified Capacity:
Program Name: Clinton County Addiction Services
Building #2, 483 State Route 11, Champlain, NY 12919 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10723_Clinto.pdf
The Community Action Organization of Western New York, Inc. Provider Number: 46 Mr. L. Nathan Hare, CEO/President Telephone - (716)-881-5150 Administrative Office: Suite 150, 45 Jewett Avenue, Buffalo, NY 14214
Certificate Number: 220410379 Renewal Effective: 05/01/2020 Anticipated Recert Review: 4/30/2022 Program Location: 1st Floor, 1237 Main Street, Buffalo, New York 14209 Service Type: Opioid Treatment Program (822) PRU: 13 Certified Capacity: 430 Capacity Lifted Program Name: Drug Abuse Research and Treatment (DART) Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10379_Commun.pdf
The Community Place of Greater Rochester, Inc. Provider Number: 42880 Mr. Scott Benjamin, Chief Executive Officer Telephone - 585-327-7200 Ext 112 Administrative Office: 57 Central Park, Rochester, NY 14605
September 21, 2021 Page 49 of 225 Certificate Number: 240511803 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2024 Program Location: Level 1 & Level Intermediate, 145 Parsells Avenue, Rochester, New York 14609 Service Type: Prevention Counseling PRU: 90849 Certified Capacity:
Program Name:
NE and NW HighSchool at the Frederick Douglas Campus, 940 Fernwood Park, Rochester, NY 14609 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11803_Commun.pdf
Concern for Independent Living, Inc. Provider Number: 16390 Mr. Ralph Fasano, Executive Director Telephone - (631)-758-0474 Administrative Office: 312 Expressway Drive South, Medford, NY 11763
Certificate Number: 191011769 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 10/31/2019 Program Location: 72 Riviera Drive, Selden, New York 11784 Service Type: Supportive Living (819) PRU: 52590 Certified Capacity: 3
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11769_Concer.pdf
Concourse Medical Center, Inc. Provider Number: 43050 Ms. Ana Matos, Acting Executive Director Telephone - (718)-665-9340 Ext 118 Administrative Office: 880 Morris Avenue, Bronx, NY 10451
Certificate Number: 210911295 Conditional Certificate Effective: 10/01/2020 Anticipated Recert Review: 9/30/2021 Program Location: 880 Morris Avenue, , Bronx, New York 10451 Service Type: Opioid Treatment Program (822) PRU: 829 Certified Capacity: 600 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11295_Concou.pdf
Confidential Help for Alcohol and Drugs, Inc. Provider Number: 36200 Mr. Kevin D. Hares, Executive Director Telephone - (315)-253-9786 Administrative Office: 75 Genesee Street, Auburn, NY 13021
Certificate Number: 231110727 Amendment Effective: 06/11/2021 Anticipated Recert Review: 10/31/2023 Program Location: The Piccolo Building, 1st Floor, 75 Genesee Street, , Auburn, New York 13021 Service Type: Outpatient Service (822) PRU: 50846 Certified Capacity: with Telepractice Designation
Program Name: CHAD
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10727_Confid.pdf
September 21, 2021 Page 50 of 225 Certificate Number: 230112019 Renewal Effective: 02/01/2020 Anticipated Recert Review: 1/31/2023 Program Location: The Piccolo Building, 1st Floor, 75 Genesee Street, , Auburn, New York 13021 Service Type: Prevention Counseling PRU: 90690 Certified Capacity:
Program Name:
Millard Fillmore Elementary School, South Main Street, Moravia, NY 13118 Other Service Site(s) At: Union Springs Central School, 27 North Cayuga Street, Union Springs, NY 13160 Other Service Site(s) At: Weedsport Central School, 2821 East Brutus Street, Weedsport, NY 13166 Other Service Site(s) At: Moravia Central School, South Main Street, Moravia, NY 13118 Other Service Site(s) At: Cato-Meridian Central School, 2851 State Route 370, Cato, NY 13033 Other Service Site(s) At: Southern Cayuga Central School, 2384 Route 34B, Aurora, NY 13026 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12019_Confid.pdf
Conifer Park, Inc. Provider Number: 14770 Ms. Patricia A. Wilcox, CEO Telephone - (518)-952-8323 Administrative Office: 79 Glenridge Road, Glenville, NY 12302
Certificate Number: 201010018 Amendment Effective: 11/08/2019 Anticipated Recert Review: 10/31/2020 Program Location: A1, A2, B2, C2, D1, D2, D3 & S2, 79 Glenridge Road, Glenville, New York 12302 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50849 Certified Capacity: 171 with Telepractice Designation [with the use of methadone] [using up to 13 beds for swing beds to Section 816.7 medically supervised inpatient withdrawal & stabilization service in Rooms A110, A112, A114 and A116 only]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10018_Conife.pdf
Certificate Number: 210810729 Amendment Effective: 10/16/2019 Anticipated Recert Review: 8/31/2021 Program Location: Basement,, 1st Floor and 2nd Floor, 55 Elm Street, , Glens Falls, New York 12801 Service Type: Outpatient Service (822) PRU: 51101 Certified Capacity: with Telepractice Designation
Program Name: Conifer Park Outpatient Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10729_Conife.pdf
Certificate Number: 210810730 Amendment Effective: 10/16/2019 Anticipated Recert Review: 8/31/2021 Program Location: 2nd Floor, 600 Franklin Street, , Schenectady, New York 12305 Service Type: Outpatient Service (822) PRU: 51828 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services at the additional location site at 79 Glenridge Road, Glenville only]
Program Name: Outpatient Clinic
September 21, 2021 Page 51 of 225 Cottage #1, 79 Glenridge Road, Glenville, NY 12302 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10730_Conife.pdf
Certificate Number: 210810731 Amendment Effective: 10/16/2019 Anticipated Recert Review: 8/31/2021 Program Location: 550-556 South Clinton Avenue, , Rochester, New York 14620 Service Type: Outpatient Service (822) PRU: 5265 Certified Capacity: 0 with Telepractice Designation
Program Name: Outpatient Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10731_Conife.pdf
Certificate Number: 211110732 Amendment Effective: 10/16/2019 Anticipated Recert Review: 11/30/2021 Program Location: Unit 1, 80 Sharron Avenue, , Plattsburgh, New York 12901 Service Type: Outpatient Service (822) PRU: 51575 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10732_Conife.pdf
Certificate Number: 211210733 Amendment Effective: 10/16/2019 Anticipated Recert Review: 12/31/2021 Program Location: Building 2, Left Wing, Suite #s 4, 5 and 6, 526 Old Liverpool Road, Liverpool, New York 13088 Service Type: Outpatient Service (822) PRU: 51568 Certified Capacity: with Telepractice Designation
Program Name: Victoria Square
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10733_Conife.pdf
Certificate Number: 210510738 Amendment Effective: 10/16/2019 Anticipated Recert Review: 5/31/2021 Program Location: 1st - 3rd Floors, 2435 Sixth Avenue, Troy, New York 12180 Service Type: Outpatient Service (822) PRU: 51826 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10738_Conife.pdf
Certificate Number: 200811437 Amendment Effective: 11/08/2019 Anticipated Recert Review: 8/31/2020 Program Location: C1, 79 Glenridge Road, Glenville, New York 12302 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 3814 Certified Capacity: 34 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11437_Conife.pdf
September 21, 2021 Page 52 of 225 Certificate Number: 211011809 Amendment Effective: 10/16/2019 Anticipated Recert Review: 10/31/2021 Program Location: Unit 1, 80 Sharron Avenue, , Plattsburgh, New York 12901 Service Type: Opioid Full Agonist Treatment Program (822) PRU: 52696 Certified Capacity: 100 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11809_Conife.pdf
Certificate Number: 211211944 Amendment Effective: 05/01/2020 Anticipated Recert Review: 12/31/2021 Program Location: Suite #s 4, 5 and 6, 526 Old Liverpool Road, , Liverpool, New York 13088 Service Type: Opioid Full Agonist Treatment Program (822) PRU: 52959 Certified Capacity: 200 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11944_Conife.pdf
Certificate Number: 210812065 Amendment Effective: 10/16/2019 Anticipated Recert Review: 8/31/2021 Program Location: 1st, 2nd & 3rd Floors, 2435 Sixth Avenue, , Troy, New York 12180 Service Type: Opioid Full Agonist Treatment Program (822) PRU: 53060 Certified Capacity: 75 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12065_Conife.pdf
Certificate Number: 220112135 Amendment Effective: 08/18/2020 Anticipated Recert Review: 1/31/2022 Program Location: Part 822 - OTP, 2nd Floor, 600 Franklin Street, , Schenectady, New York 12305 Service Type: Opioid Treatment Program (822) PRU: 53233 Certified Capacity: 200 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12135_Conife.pdf
Contact Community Services, Inc. Provider Number: 12480 Ms. Patricia R. Leone, Executive Director Telephone - (315)-251-1400 Ext 117 Administrative Office: 6311 Court Street Road, East Syracuse, NY 13057
Certificate Number: 220411756 Renewal Effective: 05/01/2019 Anticipated Recert Review: 4/30/2022 Program Location: Administrative Site Only:, 6311 Court Street Road, East Syracuse, New York 13057 Service Type: Prevention Counseling PRU: 90646 Certified Capacity:
Program Name:
Henninger High School, 600 Robinson Street, Syracuse, NY 13206 Other Service Site(s) At: Corcoran High School, 919 Glenwood Avenue, Syracuse, NY 13207 Other Service Site(s) At: Cicero-North Syracuse High School, 6002 Route 31, Cicero, NY 13039 Other Service Site(s) At:
September 21, 2021 Page 53 of 225 North Syracuse Junior High School, 5353 Taft Road, North Syracuse, NY 13212 Other Service Site(s) At: Nottingham High School, 3100 E. Genesee Street, Syracuse, NY 13224 Other Service Site(s) At: PSLA @ Fowler, 227 Magnolia Street, Syracuse, NY 13204 Other Service Site(s) At: Institute of Technology at Syracuse Central, 258 E. Adams Street, Syracuse, NY 13202 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11756_Contac.pdf
COPAY, INC. Provider Number: 145 Ms. Maria E. Cuadra, Executive Director/CEO Telephone - (516)-466-2509 Administrative Office: 2nd Floor, 21 North Station Plaza, Great Neck, NY 11021
Certificate Number: 210310739 Amendment Effective: 05/29/2020 Anticipated Recert Review: 3/31/2021 Program Location: 2nd Floor, 21 North Station Plaza, Great Neck, New York 11021 Service Type: Outpatient Service (822) PRU: 497 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10739_COPAYI.pdf
Cornerstone Family Healthcare Provider Number: 45040 Ms. Linda Muller, President and CEO Telephone - (845)-220-3112 Administrative Office: Suite 10, 2570 US Highway 9W, Cornwall, NY 12518
Certificate Number: 240611595 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2024 Program Location: 1st Floor, 3 Commercial Place, , Newburgh, New York 12550 Service Type: Outpatient Service (822) PRU: 52069 Certified Capacity:
Program Name: Center For Recovery
Service Type: Outpatient Rehabilitation Service (822) PRU: 52071 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11595_Corner.pdf
Certificate Number: 240311642 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: 1st Floor, 3 Commercial Place, , Newburgh, New York 12550 Service Type: Opioid Treatment Program (822) PRU: 52138 Certified Capacity: 450 Capacity Lifted Program Name: Center for Recovery Methadone Maintenance Treatment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11642_Greate.pdf
Council on Addiction Prevention and Education of Dutchess County, Inc. Provider Number: 34340 Ms. Regina Hernandez, Agency Site Director Telephone - (845)-745-6426 Administrative Office: Room 28, 807 Route 52, Fishkill, NY 12524
September 21, 2021 Page 54 of 225 Certificate Number: 240111592 Amendment Effective: 04/16/2021 Anticipated Recert Review: 1/31/2024 Program Location: Room 28, 807 Route 52, Fishkill, New York 12524 Service Type: Prevention Counseling PRU: 90674 Certified Capacity: with Telepractice Designation
Program Name:
Red Hook High School, 103 West Market Street, Red Hook, NY 12571 Other Service Site(s) At: Wappingers Central School District - Roy C. Ketchum High School, 99 Meyers Corners Road, Wappingers Falls, NY 12590 Other Service Site(s) At: Dover Union Free School District - Dover Jr. - Sr. High School, 2368 Route 22, Dover Plains, NY 12522 Other Service Site(s) At: Wappingers Central School District - Van Wyck Jr., 10 Hillside Lake Road, Wappinger Falls, NY 12590 Other Service Site(s) At: Wappingers Central School District - Wappingers Jr. High School, 30 Major MacDonald Way, Wappingers Falls, NY 12590 Other Service Site(s) At: Hyde Park Central Schools - FDR High School, 154 South Cross Road, Hyde Park, NY 12538 Other Service Site(s) At: Haviland Middle School, 23 Haviland Road, Hyde Park, NY 12538 Other Service Site(s) At: Linden Avenue Middle School, 66 West Market Street, Red Hook, NY 12501 Other Service Site(s) At: Wappingers Central School District - John Jay High School, 2012 Route 52, Hopewell Junction, NY 12533 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11592_Counci.pdf
Council on Addiction Recovery Services, Inc. Provider Number: 38160 Mr. Michael Prutsman, Executive Director Telephone - (716)-373-4303 Ext 513 Administrative Office: 201 South Union Street, P.O. Box 567, Olean, NY 14760
Certificate Number: 181210172 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 207 South Union Street, Olean, New York 14760 Service Type: Supportive Living (819) PRU: 51754 Certified Capacity: 16
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10172_Counci.pdf
Certificate Number: 190310173 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 3/31/2019 Program Location: 1351 Olean Portville Road, Weston Mills, New York 14788 Service Type: Community Residential (819) PRU: 51055 Certified Capacity: 16
Program Name: Weston Manor
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10173_Counci.pdf
September 21, 2021 Page 55 of 225 Certificate Number: 190910702 Amendment Effective: 06/05/2019 Anticipated Recert Review: 9/30/2019 Program Location: 2nd Floor, 201 South Union Street, Olean, New York 14760 Service Type: Outpatient Service (822) PRU: 50770 Certified Capacity: with Telepractice Designation
Program Name:
Community Healthy Alliance, 1 School Street, Gowanda, NY 14070 Additional Location(s) At: 86 South Main Street, Franklinville, NY 14737 Additional Location(s) At: 2nd Floor, Suite 205, 4039 Route 219, Salamanca, NY 14779 Additional Location(s) At: 1st Floor, 356 Main Street, Randolph, NY 14772 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10702_Counci.pdf
Certificate Number: 210612232 Amendment Effective: 08/17/2020 Anticipated Recert Review: 6/30/2021 Program Location: 1355 Olean Portville Road, , Weston Mills, New York 14788 Service Type: Residential Services (820) PRU: 53506 Certified Capacity: 20
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Willow House 820 Residential
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12232_Counci.pdf
Council on Alcoholism and Other Chemical Dependencies of the Finger Lakes, Inc. d/b/a Council on Alcoholism Provider Number: 37250 Mr. Timothy VanDamme, Executive Director Telephone - (315)-789-0310 Administrative Office: 620 W Washington St, Geneva, NY 14456
Certificate Number: 230312010 Renewal Effective: 04/01/2020 Anticipated Recert Review: 3/31/2023 Program Location: Schuyler County-Admin Site, Watkins Glen, New York 14891-1615, 106 South Perry Street, 100 Main Street, and Yates County-Admin Site, , Penn Yan, New York 14527 Service Type: Prevention Counseling PRU: 90707 Certified Capacity:
Program Name:
Penn Yan Elementary School, 3 School Drive, Penn Yan, NY 14527 Other Service Site(s) At: Watkins Glen Elementary School, 1st Floor, Room #447, 612 S. Decatur Street, Watkins Glen, NY 14891 Other Service Site(s) At: Dundee Central School, 55 Water Street, Dundee, NY 14837 Other Service Site(s) At: Watkins Glen High School, 301 12th Street, Watkins Glen, NY 14891 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12010_Counci.pdf
Counseling Center at Yorktown Heights, LLC Provider Number: 48620 Mr. Joseph Chelales, VP of Compliance Telephone - (646)-285-4035 Administrative Office: 141 8th Street , Brentwood, NY 11717
September 21, 2021 Page 56 of 225 Certificate Number: 230611810 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2023 Program Location: 2000 Maple Hill Street, Yorktown Heights, New York 10598 Service Type: Outpatient Service (822) PRU: 52721 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11810_Counse.pdf
Certificate Number: 220512266 Establishment Effective: 06/15/2021 Anticipated Recert Review: 5/31/2022 Program Location: 141 8th Street, , Brentwood, New York 11717 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 53557 Certified Capacity: 20
Program Name: Sunrise Detox Brentwood
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Counseling Services of New York LLC Provider Number: 44640 Mr. Brian Ketay, Operations Manager Telephone - (713)-818-6210 Administrative Office: Suite 1B, 911 Walton Avenue, Bronx, NY 10452
Certificate Number: 211011554 Amendment Effective: 07/03/2020 Anticipated Recert Review: 10/31/2021 Program Location: Suite 1B, 911 Walton Avenue, Bronx, New York 10452 Service Type: Outpatient Service (822) PRU: 52002 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11554_Counse.pdf
Credo Community Center for the Treatment of Addictions, Inc. Provider Number: 41270 Mr. John C. Wilson, Executive Director Telephone - (315)-788-1530 Ext 105 Administrative Office: 595 West Main Street, Watertown, NY 13601
Certificate Number: 210910744 Amendment OASAS Host Effective: 10/16/2019 Anticipated Recert Review: 9/30/2021 Program Location: 595 West Main Street, , Watertown, New York 13601 Service Type: Outpatient Service (822) PRU: 4986 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Integrated Outpatient Services - MH PRU: 4986 Certified Capacity:
Program Name:
First Floor West, 7714 Number Three Road, Lowville, NY 13367 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10744_CredoC.pdf
September 21, 2021 Page 57 of 225 Certificate Number: 181211239 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1st and 2nd Floors, 1130 State Street, Watertown, New York 13601 Service Type: Intensive Residential Rehabilitation (819) PRU: 7295 Certified Capacity: 15 with Telepractice Designation and up to 5 beds for children Program Name: Patricia Pond Hinckley Women's Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11239_CredoC.pdf
Certificate Number: 190111299 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 1/31/2019 Program Location: 417 Washington Street, Watertown, New York 13601 Service Type: Community Residential (819) PRU: 50262 Certified Capacity: 16 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11299_CredoC.pdf
Certificate Number: 181211360 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Basement,, 1st & 2nd Floors, 138 Winthrop Street, Watertown, New York 13601 Service Type: Community Residential (819) PRU: 1589 Certified Capacity: 15 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11360_CredoC.pdf
Certificate Number: 201011632 Amendment Effective: 10/16/2019 Anticipated Recert Review: 10/31/2020 Program Location: Jenkins Road, 24180 County Route 16, Evans Mills, New York 13637 Service Type: Residential Rehabilitation Services for Youth (817) PRU: 1347 Certified Capacity: 14 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11632_CredoC.pdf
Certificate Number: 230112028 Renewal Effective: 02/01/2020 Anticipated Recert Review: 1/31/2023 Program Location: 595 West Main Street, , Watertown, New York 13601 Service Type: Opioid Treatment Program (822) PRU: 52964 Certified Capacity: 100 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12028_CredoC.pdf
Crouse Health Hospital, Inc. Provider Number: 85010 Ms. Kimberly Boynton, Chief Executive Officer Telephone - (315)-470-7376 Administrative Office: 736 Irving Avenue, Syracuse, NY 13210
September 21, 2021 Page 58 of 225 Certificate Number: 230910439 Amendment Effective: 06/18/2021 Anticipated Recert Review: 9/30/2023 Program Location: 2nd Floor, 2775 Erie Boulevard East, , Syracuse, New York 13224 Service Type: Opioid Treatment Program (822) PRU: 1188 Certified Capacity: 800 with Telepractice Designation
Program Name: Chemical Dependence Treatment Service
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10439_Crouse.pdf
Certificate Number: 211010567 Amendment Effective: 06/18/2021 Anticipated Recert Review: 10/31/2021 Program Location: 1st and 2nd Floors, 2775 Erie Boulevard East, , Syracuse, New York 13224 Service Type: Outpatient Service (822) PRU: 704 Certified Capacity: with Telepractice Designation
Program Name: Chemical Dependence Treatment Service Service Type: Outpatient Rehabilitation Service (822) PRU: 50244 Certified Capacity: with Telepractice Designation
Program Name: Chemical Dependence Treatment Service
Commonwealth Place, 1st Floor, 6010 East Molloy Road, Syracuse, NY 13211 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10567_Crouse.pdf
Certificate Number: 210711698 Renewal Effective: 08/01/2018 Anticipated Recert Review: 7/31/2021 Program Location: 6010 East Molloy Road, Syracuse, New York 13211 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 52249 Certified Capacity: 40
Program Name: Commonwealth Place
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11698_Crouse.pdf
CS Medical Associates, P.C. d/b/a Victory Recovery Partners Provider Number: 50850 Paolo Coppola M.D., Executive Director Telephone - (631)-696-4357 Administrative Office: Suites 1 & 2, 100 Granny Road, Farmingville, NY 11738
Certificate Number: 220112176 Amendment Effective: 08/03/2020 Anticipated Recert Review: 1/31/2022 Program Location: Suites 1 & 2, 100 Granny Road, , Farmingville, New York 11738 Service Type: Outpatient Service (822) PRU: 53315 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12176_CSMedi.pdf
Certificate Number: 210812235 Amendment Effective: 09/02/2020 Anticipated Recert Review: 8/31/2021 Program Location: Suites 15 & 16, 1st Floor, 2 Coraci Blvd, , Shirley, New York 11967 Service Type: Outpatient Service (822) PRU: 53503 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
September 21, 2021 Page 59 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12235_CSMedi.pdf
Certificate Number: 210912240 Establishment Effective: 10/19/2020 Anticipated Recert Review: 9/30/2021 Program Location: 2nd Floor, B1, 727 N. Broadway, , Massapequa, New York 11758 Service Type: Outpatient Service (822) PRU: 53505 Certified Capacity: with Telepractice Designation [with ancillary withdrawal]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Delaware County Department of Mental Health Provider Number: 70050 Ms. Cynthia Heaney, Director Telephone - (607)-832-5888 Administrative Office: 1 Hospital Road, Walton, NY 13856
Certificate Number: 210510764 Amendment Effective: 06/05/2020 Anticipated Recert Review: 5/31/2021 Program Location: Human Resources Building, Suite 5, 1st Floor, 34570 State Highway 10, Hamden, New York 13782 Service Type: Outpatient Service (822) PRU: 50402 Certified Capacity: with Telepractice Designation
Program Name: Delaware County Alcohol and Drug Services
Margaretville Memorial Hospital, 1st Floor, Conference Room, 42084 State Highway 28, Margaretville, NY 12455 Additional Location(s) At: 2nd Floor, Room 222, 21 Liberty Street, Sidney, NY 13838 Additional Location(s) At: State University College of Technology at Delhi, 454 Delhi Drive, Delhi, NY 13753 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10764_Delawa.pdf
Delaware Valley Hospital, Inc. Provider Number: 81740 Mr. Rolland Bojo, President/CEO Telephone - Administrative Office: One Titus Place, Walton, NY 13856
Certificate Number: 240311368 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: One Titus Place, Walton, New York 13856 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51166 Certified Capacity: 10 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11368_Delawa.pdf
Delphi Drug and Alcohol Council, Inc. d/b/a Delphi Rise Provider Number: 37290 Ms. Sue Sullivan, CEO Telephone - Administrative Office: 835 West Main Street, Rochester, NY 14611
September 21, 2021 Page 60 of 225 Certificate Number: 210811260 Amendment Effective: 01/24/2019 Anticipated Recert Review: 8/31/2021 Program Location: 835 West Main Street, Rochester, New York 14611 Service Type: Outpatient Service (822) PRU: 6797 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11260_Delphi.pdf
Certificate Number: 220512008 Amendment Effective: 09/14/2021 Anticipated Recert Review: 5/31/2022 Program Location: Administrative Site Only:, 835 West Main Street, , Rochester, New York 14611 Service Type: Prevention Counseling PRU: 90709 Certified Capacity: 0 with Telepractice Designation
Program Name:
Newark High School, 1st Floor, Room 210, 625 Peirson Avenue, Newark, NY 14513 Other Service Site(s) At: Lyons Middle/High School, 10 Clyde Road, Lyons, NY 14489 Other Service Site(s) At: Freewill Elementary School, 1st Floor, Room 131, 4320 Canandaigua Road, Walworth, NY 14568 Other Service Site(s) At: Sodus Elementary School, Route 88, Sodus, NY 14551 Other Service Site(s) At: North Rose-Wolcott High School, Counselor's Office, 11631 Salter Colvin Road, Wolcott, NY 14590 Other Service Site(s) At: Red Creek Elementary, Middle and High School, Rooms C80, C77, M17, M5, M7 & M8, 6574 South Street, Red Creek, NY 13143 Other Service Site(s) At: Sodus High School, 54 Miller Street, Sodus, NY 14551 Other Service Site(s) At: Lincoln Elementary School, 1st Floor, Speech Room #1B, 1014 North Main Street, Newark, NY 14513 Other Service Site(s) At: Newark Middle School, 1st Floor, Room 118, 701 Peirson Avenue, Newark, NY 14513 Other Service Site(s) At: Williamson Elementary School, 6036 Highland Avenue, Williamson, NY 14589 Other Service Site(s) At: Sodus Middle School, 54 Miller Street, Sodus, NY 14551 Other Service Site(s) At: North Rose-Wolcott Leavenworth Middle School, 3rd Floor, Counselor's Office, 5957 Hartford Street, Wolcott, NY 14590 Other Service Site(s) At: Norman R. Kelly Intermediate School, 1st Floor, Room 127, 316 West Miller Street, Newark, NY 14513 Other Service Site(s) At: Thomas C. Armstrong Middle School, 1st Floor, Room 118, 6076 Ontario Center Road, Ontario Center, NY 14520 Other Service Site(s) At: James A. Beneway High School, 1st Floor, Room 107, 6200 Ontario Center Road, Ontario Center, NY 14520 Other Service Site(s) At:
September 21, 2021 Page 61 of 225 Perkins Elementary School, 1st Floor, Room 101, 439 West Maple Avenue, Newark, NY 14513 Other Service Site(s) At: Clyde-Savannah Elementary School, 215 Glasgow Street, Clyde, NY 14433 Other Service Site(s) At: Ontario Elementary School, 1st Floor, Room 114, 1784 Ridge Road, Ontario Center, NY 14520 Other Service Site(s) At: Clyde Savannah Junior/Senior High School, 215 Glasgow Street, Clyde, NY 14433 Other Service Site(s) At: Ontario Primary School, 1st Floor, Room A10, 1730 Ridge Road, Ontario Center, NY 14520 Other Service Site(s) At: Williamson Middle School, 4184 Miller Street, Williamson, NY 14589 Other Service Site(s) At: Wayne Technical & Career Center BOCES, 4440 Ridge Road, Williamson, NY 14589 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12008_Delphi.pdf
Certificate Number: 220112009 Amendment Effective: 09/14/2021 Anticipated Recert Review: 1/31/2022 Program Location: 835 West Main Street, Rochester, New York 14611 Service Type: Prevention Counseling PRU: 90708 Certified Capacity: with Telepractice Designation
Program Name:
Cobbles Elementary School, 1st Floor, Conference Room 14J, 140 Gebhardt Road, Penfield, NY 14526 Other Service Site(s) At: Honeoye Falls Lima Middle School, 619 Quaker Meeting House Road, Honeoye, NY 14472 Other Service Site(s) At: Gates Chili Middle School, 2 Spartan Way, Rochester, NY 14624 Other Service Site(s) At: Twelve Corners Elementary School, 1st Floor , Family Support Office, 2035 Monroe Avenue, Rochester, NY 14618 Other Service Site(s) At: Bay Trail Middle School, 1st Floor, Counseling Office 500L, 1760 Scribner Road, Penfield, NY 14526 Other Service Site(s) At: Florence Brasser Elementary, 1st Floor, Room 122A, 1000 Chili Coldwater Road, Rochester, NY 14606 Other Service Site(s) At: RCSD, Watertower Academy, 5th Floor, Room 516A, 175 Martin Street, Rochester, NY 14605 Other Service Site(s) At: Brockport Senior High School, 40 Allen Street, Brockport, NY 14622 Other Service Site(s) At: Gates Chili High School, 1 Spartan Way, Rochester, NY 14624 Other Service Site(s) At: Neil Armstrong Elementary, 1st Floor, Room 40, 3273 Lyell Road, Rochester, NY 14606 Other Service Site(s) At: Scribner Road Elementary School, 1st Floor, Conference Room 1BC, 1760 Scribner Road, Penfield, NY 14526 Other Service Site(s) At: Oliver Middle School, 1st Floor, Room 133, 40 Allen Street, Brockport, NY 14420 Other Service Site(s) At:
September 21, 2021 Page 62 of 225 Monroe 2 Orleans BOCES Career & Technical Education Center, 1st Floor, Room A-101, 3589 Big Ridge Road, Spencerport, NY 14559 Other Service Site(s) At: Indian Landing Elementary School, 2nd Floor, Administration Office, 702 Landing Road North, Rochester, NY 14625 Other Service Site(s) At: Harris Hill Elementary School, 1st Floor, OT/PT Room 5, 2126 Penfield Road, Penfield, NY 14526 Other Service Site(s) At: Honeoye Falls Lima High School, 83 East Street , Honeoye, NY 14472 Other Service Site(s) At: Penfield High School, 1st Floor, 25 High School Drive, Penfield, NY 14526 Other Service Site(s) At: Walt Disney Elementary, 1st Floor, Room 33, 175 Coldwater Road, Rochester, NY 14624 Other Service Site(s) At: Paul Road Elementary, 1st Floor, Room 84, 571 Paul Road, Rochester, NY 14624 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12009_Delphi.pdf
The Department of Education of the Diocese of Brooklyn Provider Number: 11460 Mr. Norwood Keaton, Executive Director Telephone - (718)-441-8921 Administrative Office: 3rd Floor, 112-06 86th Avenue, Richmond Hill, NY 11418
Certificate Number: 211111985 Renewal Effective: 12/01/2018 Anticipated Recert Review: 11/30/2021 Program Location: Queens Central Office, 3rd Floor, 112-06 86th Avenue, Richmond Hill, New York 11418 Service Type: Prevention Counseling PRU: 90758 Certified Capacity:
Program Name:
Service Type: Prevention Counseling PRU: 90757 Certified Capacity:
Program Name:
St. Joseph High School, 80 Willoughby Street, Brooklyn, NY 11201 Other Service Site(s) At: O. L. Perpetual Help Catholic Academy, 111-10 115th Street, South Ozone Park, NY 11420 Other Service Site(s) At: O. L. Trust Catholic Academy, 1696 Canarsie Road, Brooklyn, NY 11236 Other Service Site(s) At: St. Luke School, 16-01 150th Place, Whitestone, NY 11357 Other Service Site(s) At: Most Holy Redeemer Catholic Academy, 136-58 41st Avenue, Flushing, NY 11355 Other Service Site(s) At: St. Anselm Catholic Academy, 83rd Street/4th Avenue, Brooklyn, NY 11209 Other Service Site(s) At: St. Bartholomew School, 44-15 Judge Street, Elmhurst, NY 11373 Other Service Site(s) At: Immaculate Conception School, 21-63 29th Street, Long Island City, NY 11105 Other Service Site(s) At: St. Camillus Catholic Academy, 185 Beach 99th Street, Rockaway Beach, NY 11694 Other Service Site(s) At:
September 21, 2021 Page 63 of 225 Holy Family, 74-15 175th Street, Flushing, NY 11366 Other Service Site(s) At: St. Sebastian School, 39-76 58th Street, Woodside, NY 11377 Other Service Site(s) At: Sacred Heart School, 84-05 78th Avenue, Glendale, NY 11385 Other Service Site(s) At: Fontbonne Hall Academy, 9901 Shore Road, Brooklyn, NY 11209 Other Service Site(s) At: Divine Mercy Catholic Academy, 101-60 90th Street, Ozone Park, NY 11416 Other Service Site(s) At: O. L. Mercy Catholic Academy, 7025 Kessel Street, Forest Hills, NY 11375 Other Service Site(s) At: O. L. Angelus Catholic Academy, 98-05 63rd Drive, Rego Park, NY 11374 Other Service Site(s) At: Resurrection Ascension School, 85-25 61st Road, Rego Park, NY 11374 Other Service Site(s) At: Archbishop Molloy High School, 83-53 Manton Street, Jamaica, NY 11435 Other Service Site(s) At: Our Lady's Catholic Academy @ 128 St. Campus, 109-55 128th Street, South Ozone Park, NY 11420 Other Service Site(s) At: Catholic Academy of Brooklyn, 5902 6th Avenue, Brooklyn, NY 11220 Other Service Site(s) At: Holy Trinity Catholic Academy, 14-45 143rd Street, Whitestone, NY 11357 Other Service Site(s) At: St. Stanislaus Kostka Catholic Academy, 10 Newell Street, Brooklyn, NY 11222 Other Service Site(s) At: St. Kevin Catholic Academy, 45-5 195th Street, Flushing, NY 11358 Other Service Site(s) At: O. L. Guadalupe School, 1518 73rd Street, Brooklyn, NY 11228 Other Service Site(s) At: St. John's Preparatory High School, Crescent Street/21st Avenue, Astoria, NY 11105 Other Service Site(s) At: St. Brigid Catholic Academy, 438 Grove Street, Brooklyn, NY 11237 Other Service Site(s) At: St. Nicholas Tolentine School, 80-22 Parsons Boulevard, Jamaica, NY 11432 Other Service Site(s) At: St. Agnes Academic High School, 13-20 124th Street, College Point, NY 11356 Other Service Site(s) At: Midwood Catholic Academy, 1501 Hendrickson Street, Brooklyn, NY 11204 Other Service Site(s) At: St. Francis Xavier Catholic Academy, 763 President Street, Brooklyn, NY 11215 Other Service Site(s) At: St. Clare Catholic Academy, 137-25 Brookville Boulevard, Rosedale, NY 11422 Other Service Site(s) At: Sacred Heart School, 38th Avenue/216th Street, Bayside, NY 11361 Other Service Site(s) At: Queen of the Rosary Catholic Academy, 11 Catherine Street, Brooklyn, NY 11211 Other Service Site(s) At:
September 21, 2021 Page 64 of 225 St. Joseph Catholic Academy, 28-46 44th Street, Long Island City, NY 11103 Other Service Site(s) At: Blessed Sacrament School, 187 Euclid Avenue, Brooklyn, NY 11208 Other Service Site(s) At: St. Mary Gate of Heaven School, 104-06 101st Avenue, Ozone Park, NY 11416 Other Service Site(s) At: O. L. Catholic Academy @ Rockaway Boulevard Campus, 125-18 Rockaway Boulevard, South Ozone Park, NY 11420 Other Service Site(s) At: Xaverian High School, 7100 Shore Road, Brooklyn, NY 11209 Other Service Site(s) At: St. Agatha School, 736 48th Street, Brooklyn, NY 11220 Other Service Site(s) At: St. Adalbert, 52-17 83rd Street, Elmhurst, NY 11373 Other Service Site(s) At: O. L. Blessed Sacrament School, 34-45 202nd Street, Flushing, NY 11361 Other Service Site(s) At: St. Peter's Catholic Academy, 8401 23rd Avenue, Brooklyn, NY 11214 Other Service Site(s) At: St. Francis Prep High School, 6100 Francis Lewis Boulevard, Fresh Meadows, NY 11365 Other Service Site(s) At: St. Mark School, 2602 East 19th Street, Brooklyn, NY 11235 Other Service Site(s) At: Incarnation School, 89-15 Francis Lewis Boulevard, Queens Village, NY 11427 Other Service Site(s) At: Holy Cross High School, 26-20 Francis Lewis Boulevard, Flushing, NY 11358 Other Service Site(s) At: Bishop Kearney High School, 60th Street/Bay Parkway, Brooklyn, NY 11204 Other Service Site(s) At: St. Bernard School, 2030 East 69th Street, Brooklyn, NY 11234 Other Service Site(s) At: St. Francis Cabrini, 21 Bay 11th Street, Brooklyn, NY 11208 Other Service Site(s) At: Christ the King Regional High School, 68-02 Metropolitan Avenue, Middle Village, NY 11379 Other Service Site(s) At: Salve Regina Catholic Academy, 237 Jerome Street, Brooklyn, NY 11207 Other Service Site(s) At: St. Stanislaus Kostka School, 61-17 Grand Avenue, Maspeth, NY 11378 Other Service Site(s) At: O. L. Fatima School, 25-38 80th Street, Jackson Heights, NY 11370 Other Service Site(s) At: Ava Maria Catholic Academy, 158-20 101st Street, Howard Beach, NY 11414 Other Service Site(s) At: St. Francis DeSales Catholic Academy, 219 Beach 129th Street, Belle Harbor, NY 11694 Other Service Site(s) At: Notra Dame Catholic Academy, 61st & Bleecker Streets, Ridgewood, NY 11385 Other Service Site(s) At: St. Saviour High School, 588 6th Street, Brooklyn, NY 11215 Other Service Site(s) At:
September 21, 2021 Page 65 of 225 St. Matthias School, 58-25 Catalpa Avenue, Ridgewood, NY 11385 Other Service Site(s) At: Bishop Loughlin Memorial High School, 357 Clermont Avenue, Brooklyn, NY 11238 Other Service Site(s) At: Visitation Academy, Ridge Boulevard/89th Street, Brooklyn, NY 11209 Other Service Site(s) At: O. L. Lourdes Catholic Academy, 92-80 220th Street, Queens Village, NY 11428 Other Service Site(s) At: St. Ephrem School, 741 5 Ft. Hamilton Parkway, Brooklyn, NY 11228 Other Service Site(s) At: St. Patrick Catholic Academy, 420 95th Street, Brooklyn, NY 11209 Other Service Site(s) At: St. Athanasius School, 6120 Bay Parkway, Brooklyn, NY 11204 Other Service Site(s) At: Cathedral Prep School and Seminary, 56-25 92nd Street, Elmhurst, NY 11373 Other Service Site(s) At: St. Margaret School, 66-10 80th Street, Middle Village, NY 11379 Other Service Site(s) At: Mary Queens of Heaven, 1326 East 57th Street, Brooklyn, NY 11234 Other Service Site(s) At: Nazareth Regional High School, East 57th/Avenue D, Brooklyn, NY 11203 Other Service Site(s) At: Divine Wisdom Catholic Academy, 45-11 245th Street, Douglaston, NY 11363 Other Service Site(s) At: St. Mel Catholic Academy, 154-24 26th Avenue, Flushing, NY 11354 Other Service Site(s) At: O. L. Queen of Martyrs School, 72-55 Austin Street, Forest Hills, NY 11375 Other Service Site(s) At: St. Elizabeth Catholic Academy, 94-01 85th Street, Ozone Park, NY 11416 Other Service Site(s) At: Queen of All Saints, 300 Vanderbilt Avenue, Brooklyn, NY 11205 Other Service Site(s) At: Immaculate Conception School, 179-14 Dalny Road, Jamaica, NY 11432 Other Service Site(s) At: The Mary Louis Academy, 176-21 Wexford Terrace, Jamaica, NY 11432 Other Service Site(s) At: St. Catherine Genoa/St. Therese Lixieux C.A., 4410 Avenue D, Brooklyn, NY 11203 Other Service Site(s) At: St. Joan of Arc, 35-27 82nd Street, Jackson Heights, NY 11372 Other Service Site(s) At: St. Gregory the Great School, 244-44 87th Street, Bellerose, NY 11426 Other Service Site(s) At: Monsignor McClancy, 71-06 31st Avenue, East Elmhurst, NY 11370 Other Service Site(s) At: St. Francis Assisi Catholic Academy, 400 Lincoln Road, Brooklyn, NY 11225 Other Service Site(s) At: O. L. Grace School, 385 Avenue W, Brooklyn, NY 11223 Other Service Site(s) At:
September 21, 2021 Page 66 of 225 St. Pancras, 68-20 Myrtle Avenue, Glendale, NY 11385 Other Service Site(s) At: St. Andrew of Avellino School, 35-50 158th Street, Flushing, NY 11358 Other Service Site(s) At: O. L. Snows School, 79-33 258th Street, North Floral Park, NY 11004 Other Service Site(s) At: O. L. Sorrows Catholic Academy, 35-34 105th Street, Corona, NY 11368 Other Service Site(s) At: Christo Rey Brooklyn High School, 710 East 37th Street, Brooklyn, NY 11238 Other Service Site(s) At: Sacred Heart Catholic Academy, 115-50 221st Street, Cambria Heights, NY 11411 Other Service Site(s) At: St. Francis Cabrini Catholic Academy, 181 Suydam Street, Brooklyn, NY 11221 Other Service Site(s) At: Good Shepherd School, 1943 Brown Street, Brooklyn, NY 11229 Other Service Site(s) At: Devine Wisdom Catholic Academy - Bayside Campus, 56-10 214th Street, Bayside, NY 11364 Other Service Site(s) At: Queens Field Office, Holy Child Convent, 112-06 86th Avenue, Richmond Hill, NY 11418 Other Service Site(s) At: St. Edmund Preparatory High School, 2474 Ocean Avenue, Brooklyn, NY 11229 Other Service Site(s) At: St. Savious Catholic Academy, 701 8th Avenue, Brooklyn, NY 11215 Other Service Site(s) At: Brooklyn Field Office, St. Agatha Convent, 746 48th Street, Brooklyn, NY 11220 Other Service Site(s) At: St. Francis Assisi, 21-18 46th Street, Long Island City, NY 11105 Other Service Site(s) At: O. L. Hope School, 61-21 71st Street, Middle Village, NY 11379 Other Service Site(s) At: St. Edmund School, Avenue T/East 19th Street, Brooklyn, NY 11229 Other Service Site(s) At: Holy Angels Catholic Academy, 347 74th Street, Brooklyn, NY 11209 Other Service Site(s) At: St. Joseph the Worker Catholic Academy, 241 Prospect Park West, Brooklyn, NY 11215 Other Service Site(s) At: St. Leo School, 104-19 49th Avenue, Corona, NY 11368 Other Service Site(s) At: St. Helen Catholic Academy, 82-09 157th Avenue, Howard Beach, NY 11414 Other Service Site(s) At: Holy Child Jesus Catholic Academy, 86th Avenue/111th Street, Richmond Hill, NY 11418 Other Service Site(s) At: SS Joachim & Anne School, 218-19 105th Avenue, Queens Village, NY 11429 Other Service Site(s) At: St. Rose of Lima Catholic Academy, 154 Beach 84th Street, Rockaway Beach, NY 11693 Other Service Site(s) At: St. Gregory the Great Catholic Academy, 2520 Church Avenue, Brooklyn, NY 11226 Other Service Site(s) At:
September 21, 2021 Page 67 of 225 St. Thomas Apostle, 87-49 87th Street, Woodhaven, NY 11421 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11985_Depart.pdf
Department of Education, Archdiocese of New York Provider Number: 27080 Ms. Christine Cavallucci, Executive Director Telephone - (718)-904-1333 Ext 13 Administrative Office: 2789 Schurz Avenue, Bronx, NY 10465
Certificate Number: 230211994 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/28/2023 Program Location: Administrative Office, 2789 Schurz Avenue, Bronx, New York 10465 Service Type: Prevention Counseling PRU: 90837 Certified Capacity:
Program Name:
Service Type: Prevention Counseling PRU: 90833 Certified Capacity:
Program Name:
Service Type: Prevention Counseling PRU: 90835 Certified Capacity:
Program Name:
Service Type: Prevention Counseling PRU: 90838 Certified Capacity:
Program Name:
Service Type: Prevention Counseling PRU: 90839 Certified Capacity:
Program Name:
Our Lady of Lourdes High School, 2nd Floor, Room 201, 131 Boardman Road, Poughkeepsie, NY 12603 Other Service Site(s) At: St. Anthony School, Annex, 1st Floor, ADAPP Office, 34 West Nyack Road, Nanuet, NY 10954 Other Service Site(s) At: Sacred Heart Elementary School, 2nd Floor, Library/Computer Room, 34 Convent Avenue, Yonkers, NY 10703 Other Service Site(s) At: Our Lady of Mt. Carmel School, 2nd Floor, Library, 59 East Main Street, Elmsford, NY 10523 Other Service Site(s) At: St. John & Paul, 280 Weaver Street, Larchmont, NY 10538 Other Service Site(s) At: Bishop Dunn Memorial School, 50 Gidney Avenue, Newburgh, NY 12550 Other Service Site(s) At: St. Mary, Mother of the Church, 1st Floor, Library/Computer Room, 100 Jackson Street, Fishkill, NY 12524 Other Service Site(s) At: Holy Trinity School, 1st Floor, ADAPP Room, 20 Springside Avenue, Poughkeepsie, NY 12603 Other Service Site(s) At: Sacred Heart High School, Basement, Room B4, 34 Convent Avenue, Yonkers, NY 10703 Other Service Site(s) At: John A. Coleman High School, 430 Hurley Avenue, Hurley, NY 12443 Other Service Site(s) At: Salesian High School, 3rd Floor, Room 403, 148 Main Street, New Rochelle, NY 10801 Other Service Site(s) At:
September 21, 2021 Page 68 of 225 John S. Burke Catholic High School, 1st Floor, ADAPP OFFICE, 80 Fletcher Street, Goshen, NY 10924 Other Service Site(s) At: St. Margaret School, 33 North Magnolia Street, Pearl River, NY 10965 Other Service Site(s) At: St. Denis/St. Columba School, 1st Floor, ADAPP Room,
St. Paul School, 365 Kings Highway, Valley Cottage, NY 10989 Other Service Site(s) At: Our Lady of Victory School, 2nd Floor, Art Room, 38 North Fifth Avenue, Mount Vernon, NY 10550 Other Service Site(s) At: Sacred Heart School, 60 Washington Avenue, Suffern, NY 10901 Other Service Site(s) At: St. Gregory Barbarigo School, 29 Cinder Road, Garnerville, NY 10932 Other Service Site(s) At: Our Lady of Mt. Carmel School, 205 Wawayanda Avenue, Middletown, NY 10940 Other Service Site(s) At: Annunciation School, 1st Floor, Music/Teacher Room, 465 Westchester Avenue, Yonkers, NY 10707 Other Service Site(s) At: St. Mary School, 1st Floor, Art Room, 2 Convent Avenue, Wappingers Falls, NY 12590 Other Service Site(s) At: St. John School, 77 Murray Avenue, Goshen, NY 10924 Other Service Site(s) At: San Miguel Academy, 241 Liberty Street, Newburgh, NY 12550 Other Service Site(s) At: St. Augustine School, 1st Floor, ADAPP Office, Route 9, Eagle Park, Ossining, NY 10562 Other Service Site(s) At: John F. Kennedy HS, 54 Route 138, Somers, NY 10589 Other Service Site(s) At: Corpus Christi School, 3rd Floor, Resource Room, 135 South Regent Street, Port Chester, NY 10573 Other Service Site(s) At: Sacred Heart/St. Francis School, Basement, ADAPP Office, 24 South Robinson Avenue, Newburgh, NY 12550 Other Service Site(s) At: Immaculate Conception, Winterhill Road, Tuckahoe, NY 10707 Other Service Site(s) At: Albertus Magnus High School, 1st Floor, ADAPP Office, 798 Route 304, Germonds, Bardonia, NY 10954 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11994_Depart.pdf
September 21, 2021 Page 69 of 225 Certificate Number: 230212006 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/28/2023 Program Location: Administrative Site Only:, 2789 Schurz Avenue, Bronx, New York 10465 Service Type: Prevention Counseling PRU: 90771 Certified Capacity:
Program Name:
Service Type: Prevention Counseling PRU: 90834 Certified Capacity:
Program Name:
Service Type: Prevention Counseling PRU: 90836 Certified Capacity:
Program Name:
St. Jean Baptiste High School, 5th Floor, 173 East 75th Street, New York, NY 10021 Other Service Site(s) At: St. Adalbert School, 355 Morningstar Road, Staten Island, NY 10303 Other Service Site(s) At: Academy of Mt. St. Ursula, 3rd Floor, Room 311, 330 Bedford Park Boulevard, Bronx, NY 10458 Other Service Site(s) At: Sacred Heart School, 4th Floor, ADAPP Office, 95 West 168th Street, Bronx, NY 10452 Other Service Site(s) At: Immaculate Conception, 1st Floor, Mezzanine, Title I Office, 419 East 13th Street, New York, NY 10009 Other Service Site(s) At: St. Athanasius, 3rd Floor, Art Room, 830 Southern Boulevard, Bronx, NY 10459 Other Service Site(s) At: St. Joseph School, 2nd Floor, Room 201, 1946 Bathgate Avenue, Bronx, NY 10457 Other Service Site(s) At: St. Mark the Evangelist, 55 West 138th Street, New York, NY 10037 Other Service Site(s) At: St. Margaret Mary School, 3rd Floor, ADAPP Office, 121 East 177th Street, Bronx, NY 10453 Other Service Site(s) At: St. Peter's Boys High School, 4th Floor, Adjacent to Room 402, 200 Clinton Avenue, Staten Island, NY 10301 Other Service Site(s) At: Preston High School, 3rd Floor, Office, 2780 Schurz Avenue, Bronx, NY 10465 Other Service Site(s) At: Moore Catholic High School, 1st Floor, Room CV4, 100 Merrill Avenue, Staten Island, NY 10314 Other Service Site(s) At: St. Mary School, 3956 Carpenter Avenue, Bronx, NY 10466 Other Service Site(s) At: St. Joseph's Hill Academy, 850 Hylan Boulevard, Staten Island, NY 10305 Other Service Site(s) At: Holy Rosary School, 1500 Arnow Avenue, Bronx, NY 10469 Other Service Site(s) At: Our Lady Queen of Peace School, 22 Steele Avenue, Staten Island, NY 10306 Other Service Site(s) At: Cardinal Hayes High School, Mezzanine, ADAPP Office, 650 Grand Concourse, Bronx, NY 10451 Other Service Site(s) At:
September 21, 2021 Page 70 of 225 Santa Maria School, 2nd Floor, Adjacent to 4th & 5th Grade Classrooms, 1510 Zerega Avenue, Bronx, NY 10462 Other Service Site(s) At: Cathedral High School, 350 East 56th Street, New York, NY 10022 Other Service Site(s) At: St. Angela Merici School, 266 East 163rd Street, Bronx, NY 10451 Other Service Site(s) At: 1st Floor, ADAPP Office, 3893 Dyre Avenue, Bronx, NY 10466 Other Service Site(s) At: St. Brigid School, 185 East 7th Street, New York, NY 10009 Other Service Site(s) At: Our Lady Star of the Sea, 1st Floor, ADAPP Office, 5411 Amboy Road, Staten Island, NY 10312 Other Service Site(s) At: Our Lady Queen of Angels School, 229 East 112th Street, New York, NY 10029 Other Service Site(s) At: Holy Rosary Elementary School, Basement, Library, 100 Jerome Avenue, Staten Island, NY 10305 Other Service Site(s) At: St. Ann School, 125 Cromwell Avenue, Staten Island, NY 10304 Other Service Site(s) At: St. Frances de Chantal, 4th Floor, Room 406, 2962 Harding Avenue, Bronx, NY 10465 Other Service Site(s) At: Msgr. Scanlan High School, 3 1/2 Floor, Room 6, 915 Hutchinson River Parkway, Bronx, NY 10465 Other Service Site(s) At: Mt. St. Michael Academy, 3rd Floor, Room 314, 4300 Murdock Avenue, Bronx, NY 10466 Other Service Site(s) At: St. John Villa Elementary School Building C, 3rd Floor, Room 303, ADAPP Office, 57 Cleveland Place, Staten Island, NY 10305 Other Service Site(s) At: St. Benedict School, Ground Floor, The After School Room, 1016 Edison Avenue, Bronx, NY 10465 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12006_Depart.pdf
Dutchess County Department of Behavioral and Community Health (DBCH) Provider Number: 70180 Ms. Jean Marie Niebuhr, Acting Deputy Telephone - 845-486-2885 Administrative Office: Commissioner and Acting Director of Community Services 230 North Road, Poughkeepsie, NY 12601
Certificate Number: 210810628 Amendment OASAS Host Effective: 03/15/2021 Anticipated Recert Review: 8/31/2021 Program Location: 230 North Road, , Poughkeepsie, New York 12601 Service Type: Outpatient Service (822) PRU: 51770 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51924 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity: with Telepractice Designation
Program Name:
September 21, 2021 Page 71 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10628_Dutche.pdf
Dynamic Youth Community, Inc. Provider Number: 105 Mr. William A. Fusco, Executive Director Telephone - (718)-376-7923 Administrative Office: 1830 Coney Island Avenue, Brooklyn, NY 11230
Certificate Number: 190210005 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 2/28/2019 Program Location: Main Building, Women's, Dorm and Men's Dorm, 5803 Route 42, Fallsburg, New York 12733 Service Type: Intensive Residential Rehabilitation (819) PRU: 813 Certified Capacity: 86 with Telepractice Designation Main Building - 52 beds for men; Men's Dorm - 10 beds for men; and Women's Dorm - 24 beds for women
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10005_Dynami.pdf
Certificate Number: 210811509 Amendment Effective: 06/22/2020 Anticipated Recert Review: 8/31/2021 Program Location: 1830 Coney Island Avenue, Brooklyn, New York 11230 Service Type: Outpatient Service (822) PRU: 528 Certified Capacity: with Telepractice Designation
Program Name:
1808 Coney Island Avenue, Brooklyn, NY 11230 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11509_Dynami.pdf
Certificate Number: 181211663 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1830 Coney Island Avenue, Brooklyn, New York 11230 Service Type: Community Residential (819) PRU: 52160 Certified Capacity: 16 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11663_Dynami.pdf
EAC, Inc. Provider Number: 33030 Ms. Tania Peterson Chandler, Interim President & Telephone - (516)-539-0150 Administrative Office: CEO Suite 107, 50 Clinton Street, Hempstead, NY 11550
Certificate Number: 220111510 Amendment Effective: 09/04/2020 Anticipated Recert Review: 1/31/2022 Program Location: Suite 403, 4th Floor, 175 Fulton Avenue, , Hempstead, New York 11550 Service Type: Outpatient Service (822) PRU: 6815 Certified Capacity: with Telepractice Designation
Program Name: EAC Outpatient Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11510_EACInc.pdf
September 21, 2021 Page 72 of 225 Eastern Niagara Hospital, Inc. Provider Number: 81760 Ms. Anne McCaffrey, Chief Executive Officer Telephone - (716)-514-5502 Administrative Office: 521 East Avenue, Lockport, NY 14094
Certificate Number: 220311372 Renewal Effective: 04/04/2020 Anticipated Recert Review: 3/31/2022 Program Location: North Building, 3rd Floor, 521 East Avenue, , Lockport, New York 14094 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51208 Certified Capacity: 30
Program Name: Reflections Recovery Centre
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11372_Easter.pdf
EBDK at Calverton, LLC d/b/a Wellbridge Provider Number: 51130 Mr. Andrew Drazan, Chief Executive Officer Telephone - (516)-841-6363 Administrative Office: 525 Jan Way, Calverton, NY 11933
Certificate Number: 210412209 Amendment Effective: 03/15/2021 Anticipated Recert Review: 4/30/2021 Program Location: 525 Jan Way, , Calverton, New York 11933 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53478 Certified Capacity: 50 with up to 8 beds for the provision of Part 816.7 medically supervised withdrawal and stabilization services with Telepractice Designation
Program Name: Wellbridge Rehabilitation Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12209_EBDKat.pdf
Certificate Number: 210412216 Amendment Effective: 03/15/2021 Anticipated Recert Review: 4/30/2021 Program Location: 525 Jan Way, , Calverton, New York 11933 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 53476 Certified Capacity: 10 with up to 8 beds for the provision of Part 818 inpatient rehabilitation services with Telepractice Designation
Program Name: Wellbridge Stabilization Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12216_EBDKat.pdf
Certificate Number: 210412217 Amendment Effective: 03/15/2021 Anticipated Recert Review: 4/30/2021 Program Location: 525 Jan Way, , Calverton, New York 11933 Service Type: Residential Services (820) PRU: 53477 Certified Capacity: 8 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Wellbridge Residential Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12217_EBDKat.pdf
The Educational Alliance, Inc. Provider Number: 70590 Mr. Alan vanCapelle, President and CEO Telephone - (646)-395-4060 Administrative Office: 197 East Broadway, New York, NY 10002
September 21, 2021 Page 73 of 225 Certificate Number: 230611537 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2023 Program Location: New Side, 1st, 2nd and 3rd Floors, 25-29 Avenue D, New York, New York 10009 Service Type: Outpatient Service (822) PRU: 55 Certified Capacity: with Telepractice Designation
Program Name: Project Contact
150 William Street, New York, NY 10038 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11537_Educat.pdf
Certificate Number: 240312073 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: Original Side, New Side - 4th - 6th Floor, Basement - 6th Floor, 25-29 Avenue D, New York, New York 10009 Service Type: Residential Services (820) PRU: 53069 Certified Capacity: 100 with Telepractice Designation [16 beds for women only - 4th Floor]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Pride Site
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12073_TheEdu.pdf
EHS, Inc. Provider Number: 38260 Mr. Raymond Ganoe, President/CEO Telephone - (716)-847-2441 Administrative Office: 206 South Elmwood Avenue, Buffalo, NY 14201
Certificate Number: 220911877 Amendment Effective: 05/04/2020 Anticipated Recert Review: 9/30/2022 Program Location: 4th Floor, 206 South Elmwood Avenue, Buffalo, New York 14201 Service Type: Outpatient Service (822) PRU: 52843 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11877_EHSInc.pdf
Elev8 Center New York, LLC Provider Number: 50200 Ms. Donna Mae DePola, Executive Director Telephone - (646)-819-0827 Administrative Office: 151 West 136th Street, New York, NY 10030
Certificate Number: 220812151 Renewal Effective: 08/21/2020 Anticipated Recert Review: 8/31/2022 Program Location: 3rd Floor, 151 West 136th Street, New York, New York 10030 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53268 Certified Capacity: 37 with Telepractice Designation [Up to 14 of these beds, in Room #s 302 & 303, may be used for the provision of Medically Supervised Inpatient Withdrawal and Stabilization, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12151_Elev8C.pdf
September 21, 2021 Page 74 of 225 Certificate Number: 221212153 Renewal Effective: 01/01/2020 Anticipated Recert Review: 12/31/2022 Program Location: 2nd Floor, 151 West 136th Street, New York, New York 10030 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 53270 Certified Capacity: 38 with Telepractice Designation- with the use of methadone [Up to 18 of these beds, on the 2nd Floor in Room #s 202 & 204, may be used for the provision of Inpatient Rehabilitation services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12153_Elev8C.pdf
Elmcor Youth & Adult Activities, Inc. Provider Number: 114 Ms. Saeeda Dunston, Executive Director Telephone - (718)-651-0096 Ext 237 Administrative Office: 2nd Floor, 107-20 Northern Boulevard, Corona, NY 11368
Certificate Number: 181211300 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: (Residential), 107-06 Northern Boulevard, Basement, 1st, 2nd Floors, (Counseling) Basement, 1st Floor, Corona, New York 11368, 107-20 Northern Boulevard, Corona, New York 11368 Service Type: Intensive Residential Rehabilitation (819) PRU: 1283 Certified Capacity: 51 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11300_Elmcor.pdf
Certificate Number: 210611512 Amendment Effective: 03/05/2019 Anticipated Recert Review: 6/30/2021 Program Location: 1st Floor, 107-20 Northern Boulevard, , Corona, New York 11368 Service Type: Outpatient Service (822) PRU: 458 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11512_Elmcor.pdf
Certificate Number: 211111969 Amendment Effective: 09/09/2020 Anticipated Recert Review: 11/30/2021 Program Location: 2nd Floor, 33-16 108th Street, , Corona, New York 11368 Service Type: Prevention Counseling PRU: 90736 Certified Capacity: with Telepractice Designation
Program Name:
I.S. 127, 4th Floor, 9801 25th Avenue, East Elmhurst, NY 11369 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11969_Elmcor.pdf
Employee Assistance Resource Services, Inc. Provider Number: 1413 Dr Simon D. Zysman Ph.D., Founder and President Telephone - (516)-361-6960 Administrative Office: Suite B, 278 East Main Street, Smithtown, NY 11787
September 21, 2021 Page 75 of 225 Certificate Number: 240510768 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2024 Program Location: 278 East Main Street, Smithtown, New York 11787 Service Type: Outpatient Service (822) PRU: 4164 Certified Capacity: [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10768_Employ.pdf
EPIC Family of Human Service Agencies, Inc. as Sponsor, South Shore Child Guidance Association Incorporate Provider Number: 50580 Mr Thomas Hopkins, CEO Telephone - (516)-739-7733 Ext 100 Administrative Office: South Shore Child Guidance Association Incorporated as Operator, 91 Guy Lombardo Avenue, Freeport, NY 11520
Certificate Number: 230611999 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2023 Program Location: 91 Guy Lombardo Avenue, Freeport, New York 11520 Service Type: Outpatient Service (822) PRU: 52960 Certified Capacity: with Telepractice Designation
Program Name: Children's Addiction Resources and Education Center (C.A.R.E.)
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11999_EPICFa.pdf
Equinox, Inc. Provider Number: 14510 Ms. Virginia Golden, Chief Executive Officer Telephone - (518)-435-9931 Ext 5240 Administrative Office: 500 Central Avenue, Albany, NY 12206
Certificate Number: 220511801 Conditional Certificate Effective: 06/01/2021 Anticipated Recert Review: 5/31/2022 Program Location: 1st Floor, 500 Central Avenue, , Albany, New York 12206 Service Type: Outpatient Service (822) PRU: 52689 Certified Capacity: with Telepractice Designation
Program Name: Counseling Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11801_Equino.pdf
Erie County Medical Center Corporation Provider Number: 85150 Thomas J. Quatroche Jr, Ph.D., President and CEO Telephone - (716)-898-3000 Administrative Office: 462 Grider Street, Buffalo, NY 14215
Certificate Number: 210210282 Renewal Effective: 03/01/2018 Anticipated Recert Review: 2/28/2021 Program Location: Zone 3 (18 beds), 9th Floor, 462 Grider Street, Zone 4 (14 beds), Buffalo, New York 14215 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 50276 Certified Capacity: 32 [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10282_ErieCo.pdf
September 21, 2021 Page 76 of 225 Certificate Number: 240610770 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2024 Program Location: 1st Floor, 2005 Sheridan Drive, , Tonawanda, New York 14223 Service Type: Outpatient Service (822) PRU: 50282 Certified Capacity: with Telepractice Designation
Program Name: Northern Erie Clinical Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10770_ErieCo.pdf
Certificate Number: 210610771 Amendment Effective: 09/01/2020 Anticipated Recert Review: 6/30/2021 Program Location: 2nd Floor, 1285 Main Street, Buffalo, New York 14209 Service Type: Outpatient Service (822) PRU: 50278 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10771_ErieCo.pdf
Certificate Number: 210311369 Renewal Effective: 04/01/2018 Anticipated Recert Review: 3/31/2021 Program Location: 9th Floor, Zone 1, 462 Grider Street, Buffalo, New York 14215 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50277 Certified Capacity: 20
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11369_ErieCo.pdf
Certificate Number: 201111811 Amendment Effective: 09/01/2020 Anticipated Recert Review: 11/30/2020 Program Location: 5087 Broadway, Depew, New York 14043 Service Type: Outpatient Service (822) PRU: 52700 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11811_ErieCo.pdf
Exodus Transitional Community, Inc. Provider Number: 49050 Mr. Julio Medina, Executive Director Telephone - (917)-492-0990 Ext 175 Administrative Office: 2271 3rd Avenue, New York, NY 10035
Certificate Number: 210211947 Renewal Effective: 03/01/2019 Anticipated Recert Review: 2/28/2021 Program Location: 2nd & 3rd Floors, 2271 3rd Avenue, New York, New York 10035 Service Type: Outpatient Service (822) PRU: 52922 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11947_Exodus.pdf
Exponents, Inc. Provider Number: 2015 Mr. Joseph Turner J.D., President and Chief Telephone - (212)-243-3434 Ext 339 Administrative Office: Executive Officer 8th Floor, 17 Battery Place, New York, NY 10004
September 21, 2021 Page 77 of 225 Certificate Number: 221010773 Amendment Effective: 06/02/2020 Anticipated Recert Review: 9/30/2022 Program Location: 8th Floor, 17 Battery Place, New York, New York 10004 Service Type: Outpatient Service (822) PRU: 7128 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10773_Expone.pdf
Fairview Recovery Services, Inc. Provider Number: 36020 Mr. Patrick Haley LMSW, Executive Director Telephone - (607)-722-8987 Ext 224 Administrative Office: 5 Merrick Street, Binghamton, NY 13904
Certificate Number: 190610143 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 6/30/2019 Program Location: 5 Merrick Street, , Binghamton, New York 13904 Service Type: Supportive Living (819) PRU: 50092 Certified Capacity: 45 with Telepractice Designation for adults and their children {case records and administrative offices are located at 116 Fairview Avenue, Binghamton}
Program Name: Fairview Supportive Living Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10143_Fairvi.pdf
Certificate Number: 200312085 Extended Establishmen Effective: 04/01/2019 Anticipated Recert Review: 3/31/2020 Program Location: Basement & 1st Floor, 247 Court Street, Binghamton, New York 13901 Service Type: Residential Services (820) PRU: 53123 Certified Capacity: 20 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12085_Fairvi.pdf
Certificate Number: 200212166 Amendment Effective: 04/10/2019 Anticipated Recert Review: 2/29/2020 Program Location: 8 Clapham Street, , Binghamton, New York 13904 Service Type: Residential Services (820) PRU: 53301 Certified Capacity: 18 with Telepractice Designation [adult beds are for women]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: New Outlook
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12166_Fairvi.pdf
Certificate Number: 200212167 Amendment Effective: 04/10/2019 Anticipated Recert Review: 2/29/2020 Program Location: 5 Merrick Street, , Binghamton, New York 13904 Service Type: Residential Services (820) PRU: 53302 Certified Capacity: 24 with Telepractice Designation [for men]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Fairview Recovery Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12167_Fairvi.pdf
September 21, 2021 Page 78 of 225 Family & Children's Service of the Capital Region, Inc. d/b/a Capital Counseling Provider Number: 26330 Ms. Kandie Sawyer, Chief Executive Office Telephone - (518)-462-6531 Ext 114 Administrative Office: 650 Warren Street, Albany, NY 12208
Certificate Number: 211012242 Establishment Effective: 11/18/2020 Anticipated Recert Review: 10/31/2021 Program Location: 1st Floor, 650 Warren Street, , Albany, New York 12208 Service Type: Chemical Dependency Specialized Services (824) PRU: 53502 Certified Capacity: 0 with Problem Gambling designation
Program Name: Center for Problem Gambling
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Family and Children's Association Provider Number: 30120 Mr. Jeffrey L. Reynolds, President/CEO Telephone - (516)-746-0350 Administrative Office: Suite 24, 100 East Old Country Road, Mineola, NY 11501
Certificate Number: 221210774 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2022 Program Location: 180 Broadway, Hicksville, New York 11801 Service Type: Outpatient Service (822) PRU: 50923 Certified Capacity: [with ancillary withdrawal services] with Telepractice Designation
Program Name: Hicksville Drug Counseling Center
126 North Franklin Street, Hempstead, NY 11550 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10774_Family.pdf
Certificate Number: 221111966 Renewal Effective: 12/01/2019 Anticipated Recert Review: 11/30/2022 Program Location: 126 North Franklin Street, Hempstead, New York 11550 Service Type: Prevention Counseling PRU: 90665 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11966_Family.pdf
Family Counseling Services of Cortland County, Inc. Provider Number: 36350 Ms. Lisa W. Hoeschele, CEO & Executive Director Telephone - (607)-753-0234 Administrative Office: Suite B, 1st Floor, 165-177 Main Street, Cortland, NY 13045
Certificate Number: 211110777 Amendment OMH Host Effective: 04/15/2020 Anticipated Recert Review: 11/30/2021 Program Location: 1st Floor, 165-177 Main Street, Cortland, New York 13045 Service Type: Outpatient Service (822) PRU: 50991 Certified Capacity: 0 with Telepractice Designation
Program Name:
1st Floor, 257 Main Street, Binghamton, NY 13905 Additional Location(s) At: 201 Cedar Street, Oneida, NY 13421 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10777_Family.pdf
September 21, 2021 Page 79 of 225 Family Service League, Inc. Provider Number: 50440 Ms. Karen Boorshtein, President and Chief Telephone - (631)-470-6780 Administrative Office: Executive Officer 790 Park Avenue, Huntington, NY 11743
Certificate Number: 220510635 Amendment Effective: 04/05/2021 Anticipated Recert Review: 5/31/2022 Program Location: 1448 Fifth Avenue, , Bayshore, New York 11706 Service Type: Outpatient Service (822) PRU: 51813 Certified Capacity: with Telepractice Designation
Program Name: Family Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10635_Family.pdf
Certificate Number: 220710779 Renewal Effective: 08/01/2019 Anticipated Recert Review: 7/31/2022 Program Location: 1235 Montauk Highway , , Mastic, New York 11950 Service Type: Outpatient Service (822) PRU: 50994 Certified Capacity: with Telepractice Designation
Program Name: Family Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10779_Family.pdf
Certificate Number: 220711602 Renewal OMH Host Effective: 08/01/2019 Anticipated Recert Review: 7/31/2022 Program Location: Suite 300, 3rd Floor, 400 West Main Street, , Riverhead, New York 11901 Service Type: Outpatient Service (822) PRU: 52084 Certified Capacity: with Telepractice Designation
Program Name: Family Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11602_Family.pdf
Certificate Number: 210312229 Establishment Effective: 04/13/2020 Anticipated Recert Review: 3/31/2021 Program Location: Suite C, 90 Adams Avenue, , Hauppauge, New York 11788 Service Type: Outpatient Service (822) PRU: 53494 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12229_Family.pdf
Family Service Society, Inc. Provider Number: 396 Ms. Harmony Ayers-Friedlander, Executive Director Telephone - (607)-962-3148 Ext 216 Administrative Office: 280 Princeton Avenue Ext., Corning, NY 14830
Certificate Number: 220111993 Renewal Effective: 02/01/2020 Anticipated Recert Review: 1/31/2022 Program Location: Administrative Site at: Corning Area Youth Center, Office #9, 2nd Floor, 79 Flint Avenue, Corning, New York 14830 Service Type: Prevention Counseling PRU: 90585 Certified Capacity:
Program Name:
September 21, 2021 Page 80 of 225 Campbell-Savona Elementary School, 1st Floor, Room 150B, 64 East Lamoka Avenue, Savona, NY 14879 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11993_Family.pdf
Farnham, Inc. d/b/a Farnham Family Services Provider Number: 15660 Mr. Eric A. Bresee MS, LMHC, Executive Director Telephone - (315)-342-4489 Ext 2260 Administrative Office: 283 West 2nd Street, Oswego, NY 13126
Certificate Number: 220610782 Establishment Effective: 07/01/2021 Anticipated Recert Review: 6/30/2022 Program Location: 1st Floor, 283 West 2nd Street, , Oswego, New York 13126 Service Type: Outpatient Service (822) PRU: 687 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name:
14 Crossroads Drive, Fulton, NY 13069 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10782_Farnha.pdf
Certificate Number: 220411988 Amendment Effective: 05/29/2020 Anticipated Recert Review: 4/30/2022 Program Location: 1st Floor, 283 West 2nd Street, , Oswego, New York 13126 Service Type: Prevention Counseling PRU: 90648 Certified Capacity: with Telepractice Designation
Program Name:
Pulaksi Elementary School, 1st Floor, Counseling, 2 Hinman Road, Pulaski, NY 13142 Other Service Site(s) At: Fulton School District 4th Street School, Guidance Office, Education Center, 167 South 4th Street, Fulton, NY 13069 Other Service Site(s) At: Sandy Creek High School, PO Box 248, Sandy Creek, NY 13145 Other Service Site(s) At: Altmar-Parish-Williamstown High School, 639 County Route 22, Parish, NY 13131 Other Service Site(s) At: Michael A. Maroun Elementary School, 1st Floor, Room 128, 11 Elm Street, Phoenix, NY 13135 Other Service Site(s) At: CARE Program, SUNY Oswego, Sheldon Hall, Lower Level, Room 101, 7060 State Route 104, Oswego, NY 13126 Other Service Site(s) At: Mexico Middle School, 16 Fravor Road, Mexico, NY 13114 Other Service Site(s) At: Charles E. Riley Elementary School, 269 East 8th Street, Oswego, NY 13126 Other Service Site(s) At: Hannibal High School, 928 Cayuga Street, Hannibal, NY 13074 Other Service Site(s) At: Minetto Elementary School, All Purpose Room, 2411 County Route 8, Oswego, NY 13126 Other Service Site(s) At: Emerson J. Dillon Middle School (Phoenix), 116 Volney Street, Phoenix, NY 13135 Other Service Site(s) At:
September 21, 2021 Page 81 of 225 Oswego High School, 2 Buccaneer Boulevard, Oswego, NY 13126 Other Service Site(s) At: Frederick Leighton Elementary School, 1 Buccaneer Boulevard, Oswego, NY 13126 Other Service Site(s) At: John C. Birdlebough High School, 552 Main Street, Phoenix, NY 13135 Other Service Site(s) At: Oswego Middle School, 10 Mark Fitzgibbons Drive, Oswego, NY 13126 Other Service Site(s) At: Fulton Community School, 129 Curtis Street, Fulton, NY 13069 Other Service Site(s) At: Central Square Middle School, Guidance Office & 008C, 248 US Route 11, Central Square, NY 13036 Other Service Site(s) At: Volney Elementary School, 1st Floor, Counseling, 2592 State Route 3, Fulton, NY 13069 Other Service Site(s) At: Fitzhugh Park Elementary School, 195 E. Bridge Street, Oswego, NY 13126 Other Service Site(s) At: Pulaski High School, 4624 Salina Street, Pulaski, NY 13142 Other Service Site(s) At: Pulaski Middle School, 4624 Salina Street, Pulaski, NY 13142 Other Service Site(s) At: Bridges to Success, 1st Floor, Rooms 101 & 102, 80 Dutch Ridge Road, Oswego, NY 13126 Other Service Site(s) At: Mexico High School, 3338 Main Street, Mexico, NY 13114 Other Service Site(s) At: Kingsford Park School, Data Room, 275 West 5th Street, Oswego, NY 13126 Other Service Site(s) At: G. Ray Bodley High School (Fulton), 6 William Gillard Drive, Fulton, NY 13069 Other Service Site(s) At: Central Square High School, 642 South Main Street, Central Square, NY 13036 Other Service Site(s) At: Burton Ramer Tech Career Center, Room A160, 179 County Route 64, Mexico, NY 13114 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11988_Farnha.pdf
Certificate Number: 210812115 Amendment Effective: 01/24/2019 Anticipated Recert Review: 8/31/2021 Program Location: 1st Floor, 283 West Second Street, , Oswego, New York 13126 Service Type: Opioid Treatment Program (822) PRU: 53016 Certified Capacity: 100 with Telepractice Designation Capacity Lifted Program Name: Farnham Family Services OTP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12115_Farnha.pdf
Certificate Number: 220612269 Establishment Effective: 06/23/2021 Anticipated Recert Review: 6/30/2022 Program Location: 1st Floor, 111 Hamilton Street, , Mexico, New York 13114 Service Type: Outpatient Service (822) PRU: 53560 Certified Capacity: with Telepractice Designation
Program Name:
September 21, 2021 Page 82 of 225 61 Delano Street, Pulaski, NY 13142 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12269_Farnha.pdf
Federation of Organizations for the New York State Mentally Disabled, Inc. Provider Number: 16290 Ms. Barbara Faron, CEO Telephone - (631)-559-5355 Administrative Office: 1 Farmingdale Avenue, West Babylon, NY 11704
Certificate Number: 211212230 Establishment Effective: 01/04/2021 Anticipated Recert Review: 12/31/2021 Program Location: 1375 Akron Street, , Copiague, New York 11726 Service Type: Outpatient Service (822) PRU: 53500 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12230_Federa.pdf
Finger Lakes Area Counseling and Recovery Agency, Inc. Provider Number: 39040 Ms. Jennifer Carlson, CEO Telephone - (315)-462-9466 Administrative Office: 5th Floor, 28 East Main Street, Clifton Springs, NY 14432
Certificate Number: 181210179 Amendment Effective: 12/03/2018 Anticipated Recert Review: 12/31/2018 Program Location: 5th Floor, 28 East Main Street, Clifton Springs, New York 14432 Service Type: Supportive Living (819) PRU: 51066 Certified Capacity: 54 with Telepractice Designation
Program Name: Service Type: Supportive Living (819) PRU: 51794 Certified Capacity: 8 with Telepractice Designation
Program Name: Service Type: Supportive Living (819) PRU: 52699 Certified Capacity: 11 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10179_Finger.pdf
Certificate Number: 210910784 Amendment OASAS Host Effective: 10/06/2020 Anticipated Recert Review: 9/30/2021 Program Location: 1st and 2nd Floors, 246 Castle Street, , Geneva, New York 14456 Service Type: Outpatient Service (822) PRU: 51067 Certified Capacity: 0 [with ancillary withdrawal services] with Telepractice Designation
Program Name: Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10784_Finger.pdf
September 21, 2021 Page 83 of 225 Certificate Number: 210710785 Amendment Effective: 05/06/2020 Anticipated Recert Review: 7/31/2021 Program Location: 3rd Floor, 28 East Main Street, Clifton Springs, New York 14432 Service Type: Outpatient Service (822) PRU: 50072 Certified Capacity: 0 [with ancillary withdrawal services] with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10785_Finger.pdf
Certificate Number: 211010786 Renewal Effective: 11/01/2019 Anticipated Recert Review: 10/31/2021 Program Location: 310 West Union Street, Newark, New York 14513 Service Type: Outpatient Service (822) PRU: 50074 Certified Capacity: 0 [with ancillary withdrawal services] with Telepractice Designation
Program Name: FLACRA Addictions Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10786_Finger.pdf
Certificate Number: 200911569 Amendment Effective: 05/06/2020 Anticipated Recert Review: 9/30/2020 Program Location: 1 Keuka Business Park, 3rd Floor, 2466 Route 54A, , Penn Yan, New York 14527 Service Type: Outpatient Service (822) PRU: 51986 Certified Capacity: [with ancillary withdrawal services] with Telepractice Designation
Program Name: Penn Yan Outpatient Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11569_Finger.pdf
Certificate Number: 221211570 Amendment Effective: 05/06/2020 Anticipated Recert Review: 12/31/2022 Program Location: Suite 3, 1st Floor, 106 South Perry Street, Watkins Glen, New York 14891 Service Type: Outpatient Service (822) PRU: 51717 Certified Capacity: 0 [with ancillary withdrawal services] with Telepractice Designation
Program Name: FLACRA Addictions Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11570_Finger.pdf
Certificate Number: 220411816 Amendment Effective: 05/06/2020 Anticipated Recert Review: 4/30/2022 Program Location: 1386 Hathaway Drive, , Farmington, New York 14425 Service Type: Outpatient Service (822) PRU: 52776 Certified Capacity: 0 [with ancillary withdrawal services] with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11816_Finger.pdf
Certificate Number: 201111824 Amendment Effective: 10/28/2019 Anticipated Recert Review: 11/30/2020 Program Location: Building 14, 2650 East Street, , Canandaigua, New York 14424 Service Type: Community Residential (819) PRU: 52685 Certified Capacity: 15 with Telepractice Designation
Program Name:
September 21, 2021 Page 84 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11824_Finger.pdf
Certificate Number: 221111948 Renewal Effective: 12/01/2019 Anticipated Recert Review: 11/30/2022 Program Location: 4th Floor, 28 East Main Street, , Clifton Springs, New York 14432 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 52926 Certified Capacity: 11 with Telepractice Designation - [up to 11 beds may be used for the provision of residential services (stabilization)]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11948_Finger.pdf
Certificate Number: 210112132 Conditional Certificate Effective: 02/01/2020 Anticipated Recert Review: 1/31/2021 Program Location: Otte Hall, 621 Church Street, Newark, New York 14513 Service Type: Residential Services (820) PRU: 53226 Certified Capacity: 23 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12132_Finger.pdf
Certificate Number: 190312133 Amendment Effective: 12/03/2018 Anticipated Recert Review: 3/31/2019 Program Location: 2nd Floor, 28 East Main Street, Clifton Springs, New York 14432 Service Type: Residential Services (820) PRU: 53227 Certified Capacity: 19 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12133_Finger.pdf
Certificate Number: 200512173 Establishment Effective: 06/10/2019 Anticipated Recert Review: 5/31/2020 Program Location: 4th Floor, 28 East Main Street, , Clifton Springs, New York 14432 Service Type: Residential Services (820) PRU: 53308 Certified Capacity: 12 with Telepractice Designation [up to 12 beds may be used for the provision of medically supervised inpatient withdrawal & stabilization services]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Addictions Crisis Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12173_Finger.pdf
First Steps to Recovery, Inc. Provider Number: 2090 Ms. Allyne Spinner LCSW, Executive Director Telephone - (212)-307-5280 Administrative Office: Ground Floor, 312 West 47th Street, New York, NY 10036
Certificate Number: 200510787 Conditional Certificate Effective: 11/01/2019 Anticipated Recert Review: 5/31/2020 Program Location: Ground Floor, 310-312 West 47th Street, New York, New York 10036 Service Type: Outpatient Service (822) PRU: 6272 Certified Capacity: with Telepractice Designation
Program Name:
September 21, 2021 Page 85 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10787_FirstS.pdf
Certificate Number: 200411261 Conditional Certificate Effective: 11/01/2019 Anticipated Recert Review: 4/30/2020 Program Location: 1st Floor, 2990 Brighton 12th Street, Brooklyn, New York 11235 Service Type: Outpatient Service (822) PRU: 7334 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11261_FirstS.pdf
Five Towns Community Center, Inc. Provider Number: 33240 Mr. K. Brent Hill, Executive Director Telephone - (516)-239-6244 Ext 234 Administrative Office: 270 Lawrence Avenue, Lawrence, NY 11559
Certificate Number: 220811513 Amendment Effective: 09/22/2020 Anticipated Recert Review: 8/31/2022 Program Location: Rooms S4, S10-S17, S19, S25, and S31, 2nd Floor, 270 Lawrence Avenue, , Lawrence, New York 11559 Service Type: Outpatient Service (822) PRU: 765 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11513_FiveTo.pdf
Flushing Hospital and Medical Center Provider Number: 82070 Mr. Bruce J. Flanz, President & CEO Telephone - (718)-670-5918 Administrative Office: 4500 Parsons Boulevard, Flushing, NY 11355
Certificate Number: 221110246 Amendment Effective: 02/08/2021 Anticipated Recert Review: 11/30/2022 Program Location: 4500 Parsons Boulevard, , Flushing, New York 11355 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 51644 Certified Capacity: 30 [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10246_Flushi.pdf
Certificate Number: 221010788 Amendment OASAS Host Effective: 01/13/2021 Anticipated Recert Review: 10/31/2022 Program Location: 4500 Parsons Boulevard, , Flushing, New York 11355 Service Type: Outpatient Service (822) PRU: 51827 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Integrated Outpatient Services - PC PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10788_Flushi.pdf
September 21, 2021 Page 86 of 225 Forensic Consultants, Ltd. Provider Number: 16530 Mr. Michael Montgomery, Executive Director Telephone - (315)-472-1212 Administrative Office: 2112 Erie Boulevard E, Syracuse, NY 13224
Certificate Number: 210410789 Renewal Effective: 05/01/2019 Anticipated Recert Review: 4/30/2021 Program Location: Suite 200, 2112 Erie Boulevard East, Syracuse, New York 13224 Service Type: Outpatient Service (822) PRU: 51472 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10789_Forens.pdf
The Fortune Society, Inc. Provider Number: 1523 Ms. JoAnne Page Esq., CEO & President Telephone - (347)-510-3408 Administrative Office: 29-76 Northern Boulevard, Long Island City, NY 11101
Certificate Number: 240611539 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2024 Program Location: 29-76 Northern Boulevard, Long Island City, New York 11101 Service Type: Outpatient Service (822) PRU: 6287 Certified Capacity: with Telepractice Designation
Program Name:
1st Floor, 625 West 140th Street, New York, NY 10031 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11539_Fortun.pdf
Freedom Institute, Inc. Provider Number: 32106 Ms. Rachel Russell, Chief Clinical Officer Telephone - (212)-838-0044 Ext 0016 Administrative Office: 13th Floor, 515 Madison Avenue, New York, NY 10022
Certificate Number: 200610791 Amendment Effective: 04/18/2019 Anticipated Recert Review: 6/30/2020 Program Location: Suite 13B, 13th Floor, 515 Madison Avenue, , New York, New York 10022 Service Type: Outpatient Service (822) PRU: 51015 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10791_Freedo.pdf
Friends of Bridge, Inc. Provider Number: 139 Mr. James Wyler, Executive Director Telephone - (516)-825-4242 Administrative Office: 5-11 Pflug Place, Valley Stream, NY 11580
Certificate Number: 220111515 Amendment Effective: 06/10/2020 Anticipated Recert Review: 1/31/2022 Program Location: 5-11 Pflug Place, Valley Stream, New York 11580 Service Type: Outpatient Service (822) PRU: 239 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11515_Friend.pdf
September 21, 2021 Page 87 of 225 From the Ashes, Inc. d/b/a The Kenneth Peters Center for Recovery Provider Number: 17580 Mr. Eric Frieman, Aministrative Director Telephone - (914)-907-4753 Administrative Office: Suite 122 W, 1st Floor, 6800 Jericho Turnpike, Syosset, NY 11788
Certificate Number: 210410793 Amendment Effective: 05/28/2020 Anticipated Recert Review: 4/30/2021 Program Location: Suite 122W, 1st Floor, 6800 Jericho Turnpike, Syosset, New York 11791 Service Type: Outpatient Service (822) PRU: 51619 Certified Capacity: with Telepractice Designation
Program Name: The Kenneth Peters Center for Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10793_Fromth.pdf
Certificate Number: 210411637 Amendment Effective: 05/28/2020 Anticipated Recert Review: 4/30/2021 Program Location: 1st Floor, 300 Motor Parkway, Hauppauge, New York 11788 Service Type: Outpatient Service (822) PRU: 52130 Certified Capacity: with Telepractice Designation
Program Name: The Kenneth Peters Center for Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11637_Fromth.pdf
Fulton Friendship House, Inc. Provider Number: 12190 Mr. Thomas Ryan, Executive Director Telephone - (518)-725-1512 Administrative Office: 18 Cayadutta Street, P.O. Box 292, Gloversville, NY 12078
Certificate Number: 211210015 Renewal Effective: 01/01/2019 Anticipated Recert Review: 12/31/2021 Program Location: Victorian Manor, 1st-3rd Floors, Basement, 8-10 First Avenue, Gloversville, New York 12078 Service Type: Community Residential (819) PRU: 51297 Certified Capacity: 20
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10015_Fulton.pdf
Garnet Health Medical Center Provider Number: 81420 Mr. Jonathan Schiller, CEO Telephone - 845-794-3300 Ext 2100 Administrative Office: 707 East Main Street, Middletown, NY 10940
Certificate Number: 240511335 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2024 Program Location: Suite 135, 75 Crystal Run Road, Middletown, New York 10941 Service Type: Outpatient Service (822) PRU: 50932 Certified Capacity: with Telepractice Designation
Program Name: Horton Family Program for Alcoholism and Chemical Dependency
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11335_Garnet.pdf
Genesee Council on Alcoholism and Substance Abuse, Inc. Provider Number: 38100 Mr. John P. Bennett, Executive Director Telephone - (585)-815-1850 Administrative Office: 430 East Main Street, Batavia, NY 14020
September 21, 2021 Page 88 of 225 Certificate Number: 191110168 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 11/30/2019 Program Location: 2nd Floor, 430 East Main Street, Batavia, New York 14020 Service Type: Supportive Living (819) PRU: 51739 Certified Capacity: 24
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10168_Genese.pdf
Certificate Number: 181210169 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 424 East Main Street, Batavia, New York 14020 Service Type: Community Residential (819) PRU: 51203 Certified Capacity: 17
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10169_Genese.pdf
Certificate Number: 221010795 Renewal Effective: 11/01/2020 Anticipated Recert Review: 10/31/2022 Program Location: 430 East Main Street, Batavia, New York 14020 Service Type: Outpatient Service (822) PRU: 50546 Certified Capacity: with Problem Gambling and Telepractice Designations
Program Name: Genesee Council Clinic
First Baptist Church, 1st Floor, 5 Main Street, LeRoy, NY 14482 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10795_Genese.pdf
Certificate Number: 210810797 Amendment Effective: 05/28/2020 Anticipated Recert Review: 8/31/2021 Program Location: 1st Floor & Basement, 249 East Avenue & 166 McKinstry Street, Albion, New York 14411 Service Type: Outpatient Service (822) PRU: 51798 Certified Capacity: with Problem Gambling and Telepractice Designations
Program Name: Genesee Council Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10797_Genese.pdf
Certificate Number: 210912150 Amendment Effective: 05/28/2020 Anticipated Recert Review: 9/30/2021 Program Location: 430 East Main Street, Batavia, New York 14020 Service Type: Opioid Treatment Program (822) PRU: 53122 Certified Capacity: 150 with Problem Gambling and Telepractice Designations Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12150_Genese.pdf
Genesis Detox of Brooklyn, LLC Provider Number: 49600 Mr. Samuel Benitez, Chief Executive Officer Telephone - (718)-633-4673 Ext 115 Administrative Office: 449 39th Street, Brooklyn, NY 11232
September 21, 2021 Page 89 of 225 Certificate Number: 210712064 Amendment Effective: 06/01/2021 Anticipated Recert Review: 7/31/2021 Program Location: 449 39th Street, Brooklyn, New York 11232 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 53059 Certified Capacity: 35 - with the use of methadone
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12064_Genesi.pdf
Good Samaritan Hospital of Suffern, N.Y. Provider Number: 85370 Mary Leahy M.D., CEO Telephone - (845)-368-5303 Administrative Office: 2nd Floor, 255 Lafayette Avenue, Suffern, NY 10901
Certificate Number: 211110297 Renewal Deemed Effective: 01/31/2019 Anticipated Recert Review: 11/10/2021 Program Location: 3rd Floor, 255 Lafayette Avenue, Suffern, New York 10901 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 4494 Certified Capacity: 6 - with the use of methadone
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10297_GoodSa.pdf
Certificate Number: 211111370 Renewal Deemed Effective: 01/31/2019 Anticipated Recert Review: 11/10/2021 Program Location: 3rd Floor, 255 Lafayette Avenue, Suffern, New York 10901 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 6972 Certified Capacity: 11
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11370_GoodSa.pdf
Greenwich House, Inc. Provider Number: 50730 Mr. Darren Bloch, Chief Executive Officer Telephone - (212)-991-0003 Ext 201 Administrative Office: 6th Floor, 122 West 27th Street, New York, NY 10001
Certificate Number: 211110382 Amendment Effective: 10/02/2020 Anticipated Recert Review: 11/30/2021 Program Location: 190 Mercer Street, New York, New York 10012 Service Type: Opioid Treatment Program (822) PRU: 18 Certified Capacity: 800 with Telepractice Designation Capacity Lifted Program Name: Greenwich House East
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10382_Greenw.pdf
Certificate Number: 240610801 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2024 Program Location: 6th Floor, 122 West 27th Street, New York, New York 10001 Service Type: Outpatient Service (822) PRU: 586 Certified Capacity: with Telepractice Designation
Program Name: Greenwich House Counseling Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10801_Greenw.pdf
September 21, 2021 Page 90 of 225 The Guidance Center of Westchester, Inc. Provider Number: 23500 Ms. Amy Gelles, Executive Director Telephone - (914)-613-0700 Ext 7074 Administrative Office: 256 Washington Street, Mount Vernon, NY 10553
Certificate Number: 221110359 Renewal OASAS Host Effective: 12/01/2020 Anticipated Recert Review: 11/30/2022 Program Location: Room #s 1, 2, & 3 (Lower Level) - Voc. Assistance Project, Group Room (Lower Level) - CD Groups (Relapse/Recovery), Room #219A-Waiting/Receiving Area (Upper Level) - Methadone Dispensing, Group Room (Lower Level) Co-Occur./OMH Groups, 20 Sickles Avenue Service Type: Opioid Treatment Program (822) PRU: 397 Certified Capacity: 250 with Telepractice Designation
Program Name: Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10359_Guidan.pdf
Certificate Number: 211111787 Conditional Certificate Effective: 12/01/2020 Anticipated Recert Review: 11/30/2021 Program Location: 3rd and 4th Floors, 256 Washington Street, Mount Vernon, New York 10553 Service Type: Outpatient Service (822) PRU: 52641 Certified Capacity: with Telepractice Designation
Program Name: Mount Vernon Sunrise
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11787_Guidan.pdf
Halfway Houses of Westchester, Inc. Provider Number: 34020 Mr. Aflred Pride, Executive Director Telephone - (914)-946-0949 Administrative Office: 1st Floor, 14 Longview Avenue, White Plains, NY 10605
Certificate Number: 181210115 Conditional Certificate Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1st & 2nd Floors, Basement,, 14 Longview Avenue, White Plains, New York 10605 Service Type: Community Residential (819) PRU: 50061 Certified Capacity: 10
Program Name: Hawthorne House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10115_Halfwa.pdf
Hamilton-Madison House, Inc. Provider Number: 50370 Ms. Isabel Ching, Executive Director Telephone - (212)-349-3724 Ext 9321 Administrative Office: 2nd Floor, 253 South Street, New York, NY 10002
Certificate Number: 211010804 Amendment Effective: 10/02/2020 Anticipated Recert Review: 10/31/2021 Program Location: 2nd Floor, 253 South Street, New York, New York 10002 Service Type: Outpatient Service (822) PRU: 50049 Certified Capacity: with Telepractice Designation
Program Name: Asian American Recovery Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10804_Hamilt.pdf
September 21, 2021 Page 91 of 225 HANAC, Inc. Provider Number: 16670 Mr. John P. Kaiteris, Chief Operating Officer Telephone - (212)-204-1200 Ext 105 Administrative Office: 27-40 Hoyt Avenue South, Astoria, NY 11102
Certificate Number: 210611516 Amendment Effective: 08/25/2020 Anticipated Recert Review: 6/30/2021 Program Location: 2nd Floor, 31-14 30th Avenue, Astoria, New York 11102 Service Type: Outpatient Service (822) PRU: 6118 Certified Capacity: with Telepractice Designation
Program Name:
1st & 2nd Floors, 23-16 30th Avenue, Astoria, NY 11102 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11516_HANACI.pdf
Hands on Health Associates, LLC Provider Number: 48040 Ms. Marcia Allen-Booker, CEO Telephone - (347)-547-3626 Administrative Office: 249 Pennsylvania Avenue, Brooklyn, NY 11207
Certificate Number: 221012036 Amendment Effective: 07/03/2020 Anticipated Recert Review: 10/31/2022 Program Location: 2nd and 3rd Floors, 249 Pennsylvania Avenue, Brooklyn, New York 11207 Service Type: Outpatient Service (822) PRU: 52619 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12036_Handso.pdf
Harrison Youth Council, Inc. Provider Number: 27910 Ms. Amanda Ammirati, Executive Director Telephone - (914)-835-7500 Administrative Office: 1st Floor, 84 Calvert Street, Harrison, NY 10528
Certificate Number: 211211971 Amendment Effective: 07/02/2021 Anticipated Recert Review: 12/31/2021 Program Location: 1st Floor, 84 Calvert Street, Harrison, New York 10528 Service Type: Prevention Counseling PRU: 90663 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11971_Harris.pdf
Hazelden/New York Provider Number: 2141 Ms. Eliana Leve, Director NY Services Telephone - (646)-601-7028 Administrative Office: 12th Floor, 322 8th Avenue, New York, NY 10001
Certificate Number: 210811517 Amendment Effective: 07/03/2020 Anticipated Recert Review: 8/31/2021 Program Location: 12th Floor, 322 8th Avenue, , New York, New York 10001 Service Type: Outpatient Service (822) PRU: 6978 Certified Capacity: with Telepractice Designation
Program Name:
September 21, 2021 Page 92 of 225 283 West Broadway, New York, NY 10013 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11517_Hazeld.pdf
HealthCare Choices NY, Inc. Provider Number: 49950 Ms. Maria Siebel, CEO Telephone - (718)-234-0073 Administrative Office: 6209 16th Avenue, Brooklyn, NY 11204
Certificate Number: 230912161 Amendment Effective: 06/16/2021 Anticipated Recert Review: 9/30/2023 Program Location: 6209 16th Avenue, , Brooklyn, New York 11204 Service Type: Outpatient Service (822) PRU: 53210 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12161_Health.pdf
Heartshare Human Services of New York as Sponsor, St. Vincent's Services, Inc. as Operator Provider Number: 22300 Ms Dawn V. Saffayeh, Executive Director Telephone - (718)-422-2302 Administrative Office: St. Vincent's Services, Inc. as Operator, 5th Floor, 66 Boerum Place, Brooklyn, NY 11201
Certificate Number: 200911020 Renewal Effective: 10/01/2018 Anticipated Recert Review: 9/30/2020 Program Location: Basement & 1st Floor, 66 Boerum Place, Brooklyn, New York 11201 Service Type: Outpatient Service (822) PRU: 7310 Certified Capacity: 0 with Telepractive Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11020_Hearts.pdf
Helio Health, Inc. Provider Number: 36090 Mr. Jeremy Klemanski, Chief Executive Officer Telephone - (315)-474-5506 Administrative Office: 555 E. Genesee Street, Syracuse, NY 13202
Certificate Number: 200811038 Amendment OASAS Host Effective: 04/15/2020 Anticipated Recert Review: 8/31/2020 Program Location: 1st, 2nd & 3rd Floors, 329 North Salina Street, , Syracuse, New York 13203 Service Type: Outpatient Service (822) PRU: 50041 Certified Capacity: 0 with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]
Program Name: Meadows Outpatient Services Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Suite #201, 321 West Onondaga Street , Syracuse, NY 13202 Additional Location(s) At: Bldg 5, 1st Floor, 960 Salt Springs Road, Syracuse, NY 13224 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11038_HelioH.pdf
September 21, 2021 Page 93 of 225 Certificate Number: 210911408 Amendment Effective: 01/01/2021 Anticipated Recert Review: 9/30/2021 Program Location: 1st & 2nd Floors, Basement,, 847 James Street, , Syracuse, New York 13203 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50040 Certified Capacity: 40 - [up to 40 beds may be used for the provision of medically supervised inpatient withdrawal & stabilization services, as needed]
Program Name: Helio Health Inpatient Facility
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11408_HelioH.pdf
Certificate Number: 211111455 Amendment Effective: 01/01/2021 Anticipated Recert Review: 11/30/2021 Program Location: 1st Floor & Lower Level, 847 James Street, , Syracuse, New York 13203 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 51962 Certified Capacity: 25 - [up to 25 beds may be used for the provision of inpatient rehabilitation services, as needed]
Program Name: Evaluation Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11455_HelioH.pdf
Certificate Number: 220811707 Amendment Effective: 04/30/2021 Anticipated Recert Review: 8/31/2022 Program Location: 1st Floor & Annex B, 1350 University Avenue, , Rochester, New York 14607 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 52300 Certified Capacity: 30 with Telepractice Designation - [all of these beds may be used for the provision of inpatient rehabilitation services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11707_HelioH.pdf
Certificate Number: 230912069 Renewal Effective: 10/01/2020 Anticipated Recert Review: 9/30/2023 Program Location: , New York Service Type: Opioid Treatment Program (822) PRU: 53067 Certified Capacity: 250 with Telepractice Designation [with ancillary withdrawal services for up to 25 patients] Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12069_HelioH.pdf
Certificate Number: 220312136 Amendment Effective: 07/03/2020 Anticipated Recert Review: 3/31/2022 Program Location: Building 1 - Wings E, F & G, 249 Glenwood Road, , Binghamton, New York 13905 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 53211 Certified Capacity: 30 [up to 20 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed] with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12136_HelioH.pdf
September 21, 2021 Page 94 of 225 Certificate Number: 231012174 Renewal Effective: 11/01/2020 Anticipated Recert Review: 10/31/2023 Program Location: Suite 100, 1213 Court Street, , Utica, New York 13502 Service Type: Opioid Treatment Program (822) PRU: 53296 Certified Capacity: 250 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12174_HelioH.pdf
Certificate Number: 220712192 Establishment Effective: 08/01/2021 Anticipated Recert Review: 7/31/2022 Program Location: Harriet May Mills House, 1074 West Genesee Street, , Syracuse, New York 13204 Service Type: Residential Services (820) PRU: 53348 Certified Capacity: 12 with Telepractice Designation [for women]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: The Women's Halfway House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12192_HelioH.pdf
Certificate Number: 210712193 Amendment Effective: 10/21/2020 Anticipated Recert Review: 7/31/2021 Program Location: 168 Lincoln Avenue, , Syracuse, New York 13204 Service Type: Residential Services (820) PRU: 53349 Certified Capacity: 30 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Lincoln House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220712194 Establishment Effective: 08/01/2021 Anticipated Recert Review: 7/31/2022 Program Location: 3606 James Street, , Syracuse, New York 13206 Service Type: Residential Services (820) PRU: 53350 Certified Capacity: 16 with Telepractice Designation [for men]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: The Men's Halfway House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12194_HelioH.pdf
Certificate Number: 230212203 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/28/2023 Program Location: Building 1 - Wings E, F & G, 249 Glenwood Road, , Binghamton, New York 13905 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53359 Certified Capacity: 20 [up to 20 of these beds may be used for the provision of Section 816.7 medically supervised inpatient withdrawal & stabilization services, as needed]
Program Name: Helio Health Binghamton Inpatient Rehabilitation
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12203_HelioH.pdf
September 21, 2021 Page 95 of 225 Certificate Number: 201212225 Amendment Effective: 10/21/2020 Anticipated Recert Review: 12/31/2020 Program Location: 1st and 2nd Floor, 4567 Crossroads Park Drive, Liverpool, New York 13088 Service Type: Residential Services (820) PRU: 53444 Certified Capacity: 75 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Elements
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12225_HelioH.pdf
Certificate Number: 211212248 Amendment Effective: 08/26/2021 Anticipated Recert Review: 12/31/2021 Program Location: 500 Whitesboro Street , , Utica, New York 13502 Service Type: Outpatient Service (822) PRU: 53523 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12248_HelioH.pdf
Certificate Number: 211212250 Amendment Effective: 01/21/2021 Anticipated Recert Review: 12/31/2021 Program Location: Basement, 1st, & 2nd Floo, 500 Whitesboro Street, , Utica, New York 13502 Service Type: Residential Services (820) PRU: 53528 Certified Capacity: 44 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12250_HelioH.pdf
Certificate Number: 220312263 Establishment Effective: 04/30/2021 Anticipated Recert Review: 3/31/2022 Program Location: 1st Floor & Annex B, 1350 University Avenue, , Rochester, New York 14607 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53559 Certified Capacity: 10 with Telepractice Designation - [all of these beds may be used for the provision of medically supervised withdrawal & stabilization services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12263_HelioH.pdf
Certificate Number: 220512268 Establishment Effective: 06/07/2021 Anticipated Recert Review: 5/31/2022 Program Location: 121-125 Green Street, , Syracuse, New York 13203 Service Type: Residential Services (820) PRU: 53443 Certified Capacity: 30 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Green Street Residential Rehabilitation
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12268_HelioH.pdf
September 21, 2021 Page 96 of 225 Certificate Number: 220712270 Establishment Effective: 08/01/2021 Anticipated Recert Review: 7/31/2022 Program Location: Suite 400, 329 North Salina Street, , Syracuse, New York 13203 Service Type: Residential Services (820) PRU: 53565 Certified Capacity: 80 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Hispanic Counseling Center, Inc. Provider Number: 33160 Ms. Gladys Serrano, Chief Executive Officer Telephone - (516)-538-2613 Ext 227 Administrative Office: 344 Fulton Avenue, Hempstead, NY 11550
Certificate Number: 231110806 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: 1st & 2nd Floors, 344 Fulton Avenue, Hempstead, New York 11550 Service Type: Outpatient Service (822) PRU: 50972 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10806_Hispan.pdf
HONOR ehg, Inc. Provider Number: 34210 Mr. Christopher Molinelli, Executive Director Telephone - (845)-343-7115 Administrative Office: Suite 300, 38 Seward Avenue, Middletown, NY 10940
Certificate Number: 200212012 Conditional Certificate Effective: 10/01/2019 Anticipated Recert Review: 2/29/2020 Program Location: Suite 300, 1st Floor, 38 Seward Avenue, Middletown, New York 10940 Service Type: Residential Services (820) PRU: 53463 Certified Capacity: 20
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12012_HONORe.pdf
Hope For Youth, Inc. Provider Number: 16320 David J. Hegarty Ph.D., Executive Director Telephone - (631)-782-6501 Ext 111 Administrative Office: 201 Dixon Avenue, Amityville, NY 11701
Certificate Number: 200711767 Amendment Effective: 07/03/2020 Anticipated Recert Review: 7/31/2020 Program Location: 201 Dixon Avenue, Amityville, New York 11701 Service Type: Outpatient Service (822) PRU: 52608 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11767_HopeFo.pdf
September 21, 2021 Page 97 of 225 Hope House, Inc. Provider Number: 35300 Mr. Kevin M. Connally, Executive Director Telephone - (518)-482-4673 Ext 216 Administrative Office: 573 Livingston Avenue, Albany, NY 12206
Certificate Number: 210510809 Amendment Effective: 09/04/2020 Anticipated Recert Review: 5/31/2021 Program Location: 3rd Floor, 747 Madison Avenue, Albany, New York 12208 Service Type: Outpatient Service (822) PRU: 51291 Certified Capacity: with Telepractice Designation
Program Name:
St. Anne's Institute, 160 North Main Avenue, Albany, NY 12206 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10809_HopeHo.pdf
Certificate Number: 181211303 Amendment Effective: 10/15/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1st & 2nd Floors, 890 Madison Avenue, , Albany, New York 12208 Service Type: Community Residential (819) PRU: 51834 Certified Capacity: 21 and up to 12 beds for children Program Name: Hope House Women and Children's Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11303_HopeHo.pdf
Certificate Number: 200612198 Establishment Effective: 07/01/2019 Anticipated Recert Review: 6/30/2020 Program Location: 2 Holland Avenue, , Albany, New York 12209 Service Type: Supportive Living (819) PRU: 53379 Certified Capacity: 6
Program Name: Hope House Next Step
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12198_HopeHo.pdf
Certificate Number: 200612199 Establishment Effective: 07/01/2019 Anticipated Recert Review: 6/30/2020 Program Location: 2 Holland Avenue, , Albany, New York 12209 Service Type: Intensive Residential Rehabilitation (819) PRU: 53380 Certified Capacity: 20
Program Name: Hope House Next Step
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12199_HopeHo.pdf
Certificate Number: 240512205 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2024 Program Location: 261 North Pearl Street, , Albany, New York 12207 Service Type: Residential Services (820) PRU: 53446 Certified Capacity: 35
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Bette Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12205_HopeHo.pdf
September 21, 2021 Page 98 of 225 Certificate Number: 210112215 Establishment Effective: 02/24/2020 Anticipated Recert Review: 1/31/2021 Program Location: 577 Livingston Avenue, , Albany, New York 12206 Service Type: Residential Services (820) PRU: 53471 Certified Capacity: 20 [for women]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Women's Recovery Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12215_HopeHo.pdf
Certificate Number: 220412256 Establishment Effective: 05/01/2021 Anticipated Recert Review: 4/30/2022 Program Location: 1724 Fifth Avenue , , Troy, New York 12180 Service Type: Outpatient Service (822) PRU: 53454 Certified Capacity: with Telepractice Designation
Program Name: Hope House Outpatient Clinic Troy
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12256_HopeHo.pdf
Certificate Number: 220412257 Establishment Effective: 05/01/2021 Anticipated Recert Review: 4/30/2022 Program Location: 559-565 Sixth Avenue, , Troy, New York 12182 Service Type: Supportive Living (819) PRU: 53456 Certified Capacity: 17
Program Name: Hope House Troy Supportive Living
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12257_HopeHo.pdf
Certificate Number: 220412258 Establishment Effective: 05/01/2021 Anticipated Recert Review: 4/30/2022 Program Location: 106-108 Ninth Street, , Troy, New York 12180 Service Type: Community Residential (819) PRU: 53455 Certified Capacity: 16
Program Name: Hope House Elizabeth House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12258_HopeHo.pdf
Certificate Number: 220512273 Establishment Effective: 06/01/2021 Anticipated Recert Review: 5/31/2022 Program Location: 573 Livingston Avenue, , Albany, New York 12206 Service Type: Residential Services (820) PRU: 53551 Certified Capacity: 20
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Men's Recovery Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12273_HopeHo.pdf
Horizon Health Services, Inc. Provider Number: 11130 Ms. Anne D. Constantino, President and Chief Telephone - (716)-831-2700 Administrative Office: Executive Officer 55 Dodge Road, Getzville, NY 14068
September 21, 2021 Page 99 of 225 Certificate Number: 220310811 Renewal Effective: 04/01/2020 Anticipated Recert Review: 3/31/2022 Program Location: 3020 Bailey Avenue, Buffalo, New York 14215 Service Type: Outpatient Service (822) PRU: 50031 Certified Capacity: 0 with Telepractice Designation
Program Name: Bailey Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10811_Horizo.pdf
Certificate Number: 230910812 Renewal Effective: 10/01/2020 Anticipated Recert Review: 9/30/2023 Program Location: 1370 Niagara Falls Boulevard, Tonawanda, New York 14150 Service Type: Outpatient Service (822) PRU: 50029 Certified Capacity: 0 with Telepractice Designation
Program Name: Boulevard Recovery Center
37 Niagara Street, Tonawanda, NY 14150 Additional Location(s) At: 55 Dodge Road , Getzville, NY 14068 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10812_Horizo.pdf
Certificate Number: 230210814 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/28/2023 Program Location: Suite 350, 699 Hertel Avenue, Buffalo, New York 14207 Service Type: Outpatient Service (822) PRU: 51197 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10814_Horizo.pdf
Certificate Number: 240310815 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: 77 Broadway Street, Buffalo, New York 14203 Service Type: Outpatient Service (822) PRU: 51198 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10815_Horizo.pdf
Certificate Number: 221210821 Renewal Effective: 01/01/2020 Anticipated Recert Review: 12/31/2022 Program Location: 637 Davison Road, Lockport, New York 14094 Service Type: Outpatient Service (822) PRU: 51804 Certified Capacity: 0 with Telepractice Designation
Program Name: Lockport Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10821_Horizo.pdf
September 21, 2021 Page 100 of 225 Certificate Number: 230111662 Amendment Effective: 12/31/2020 Anticipated Recert Review: 1/31/2023 Program Location: 2400 Pine Avenue, Niagara Falls, New York 14301 Service Type: Outpatient Service (822) PRU: 52194 Certified Capacity: 0 with Telepractice Designation
Program Name: Pine Avenue Recovery Center
1st Floor, 6321 Inducon Drive East, Sanborn, NY 14132 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11662_Horizo.pdf
Certificate Number: 230511680 Renewal OASAS Host Effective: 06/01/2021 Anticipated Recert Review: 5/31/2023 Program Location: 2563 Union Road, , Cheektowaga, New York 14227 Service Type: Outpatient Service (822) PRU: 52214 Certified Capacity: 0 with Telepractice Designation
Program Name: Union Losson Recovery Center Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity: 0
Program Name: Union Losson Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11680_Horizo.pdf
Certificate Number: 240411690 Renewal OASAS Host Effective: 05/01/2021 Anticipated Recert Review: 4/30/2024 Program Location: 314 Ellicott Street, , Batavia, New York 14020 Service Type: Outpatient Service (822) PRU: 52225 Certified Capacity: 0 with Telepractice Designation
Program Name: Batavia Recovery Center Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity: 0
Program Name: Batavia Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11690_Horizo.pdf
Certificate Number: 220911714 Renewal Effective: 10/01/2019 Anticipated Recert Review: 9/30/2022 Program Location: 6495 Transit Road, East Amherst, New York 14051 Service Type: Outpatient Service (822) PRU: 52529 Certified Capacity: 0 with Telepractice Designation
Program Name: East Amherst Family Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11714_Horizo.pdf
Certificate Number: 220111772 Amendment Effective: 04/25/2019 Anticipated Recert Review: 1/31/2022 Program Location: 3345 Southwestern Boulevard, , Orchard Park, New York 14127 Service Type: Outpatient Service (822) PRU: 52617 Certified Capacity: 0 with Telepractice Designation
Program Name:
September 21, 2021 Page 101 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11772_Horizo.pdf
Horizon Village, Inc. Provider Number: 25820 Ms. Anne D. Constantino, President /CEO Telephone - (716)-831-2700 Administrative Office: 55 Dodge Rd., Getzville, NY 14068
Certificate Number: 220211820 Amendment Effective: 07/10/2020 Anticipated Recert Review: 2/28/2022 Program Location: 1st Floor, 291 Elm Street, Buffalo, New York 14203 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 52730 Certified Capacity: 10 with Telepractice Designation
Program Name: Terrace House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11820_Horizo.pdf
Certificate Number: 181212030 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 6302 Inducon Drive East, Sanborn, New York 14132 Service Type: Residential Services (820) PRU: 53487 Certified Capacity: 25 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Delta Village
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12030_Horizo.pdf
Certificate Number: 181212039 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 6301 Inducon Drive East, Sanborn, New York 14132 Service Type: Residential Services (820) PRU: 53485 Certified Capacity: 50 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Horizon Village
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12039_Horizo.pdf
Certificate Number: 181212040 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 6331 Inducon Drive East, Sanborn, New York 14132 Service Type: Residential Services (820) PRU: 53486 Certified Capacity: 25 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Freedom Village
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12040_Horizo.pdf
Certificate Number: 240112044 Renewal Effective: 02/01/2021 Anticipated Recert Review: 1/31/2024 Program Location: 1st and 2nd Floors, 291 Elm Street, Buffalo, New York 14203 Service Type: Residential Services (820) PRU: 53484 Certified Capacity: 58 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Terrace House
September 21, 2021 Page 102 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12044_Horizo.pdf
Certificate Number: 190912159 Establishment Effective: 10/01/2018 Anticipated Recert Review: 9/30/2019 Program Location: 6298 Inducon Drive East, Sanborn, New York 14132 Service Type: Residential Services (820) PRU: 53488 Certified Capacity: 25 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Aurora Village
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12159_Horizo.pdf
Hornell Area Concern for Youth, Inc. Provider Number: 397 Ms. Susan Hooker, Executive Director Telephone - (607)-324-0808 Administrative Office: 76 East Main Street, Hornell, NY 14843
Certificate Number: 220611989 Renewal Effective: 07/01/2019 Anticipated Recert Review: 6/30/2022 Program Location: Room 1, 1st Floor, 76 East Main Street, Hornell, New York 14843 Service Type: Prevention Counseling PRU: 90586 Certified Capacity:
Program Name:
Canisteo-Greenwood Central School District, Psych. Room, 1st Floor, Room 178B, 84 Greenwood Street, Canisteo, NY 14823 Other Service Site(s) At: Canisteo-Greenwood Central School District, Ground Floor, Rooms 109 & 153, 120 Greenwood Street, Canisteo, NY 14823 Other Service Site(s) At: Hornell High School Main Office, Conference Room 111 &, Guidance Office, Conference Room, 1st Floor, 134 Seneca Street, Hornell, NY 14843 Other Service Site(s) At: Canisteo Presbyterian Church, 10 South Main Street, Canisteo, NY 14823 Other Service Site(s) At: Jasper-Troupsburg High School Main Building, 1st Floor, Room G100C, 3769 North Main Street, Jasper, NY 14855 Other Service Site(s) At: Intermediate School, 1st Floor, Nurse's Office, Room 108, 71 Buffalo Street, Hornell, NY 14843 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11989_Hornel.pdf
Hospitality House T.C., Inc. Provider Number: 170 Mr Young Do, Executive Director Telephone - (518)-434-6468 Ext 106 Administrative Office: 271 Central Avenue, Albany, NY 12206
Certificate Number: 211112048 Establishment Effective: 12/28/2020 Anticipated Recert Review: 11/30/2021 Program Location: 271 Central Avenue, , Albany, New York 12206 Service Type: Residential Services (820) PRU: 53452 Certified Capacity: 45
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12048_Hospit.pdf
September 21, 2021 Page 103 of 225 Housing Works, Inc. as Sponsor, Bailey House, Inc. as Operator Provider Number: 1738 Mr. Andrew Coamey, Executive Director Telephone - (347)-473-7400 Administrative Office: 2nd Floor, 120 Lawrence Street, Brooklyn, NY 11201
Certificate Number: 221211962 Amendment Effective: 06/05/2020 Anticipated Recert Review: 12/31/2022 Program Location: The Rand Harlan Center for Housing, Wellness and Community, 3rd Floor, 1751 Park Avenue, New York, New York 10035 Service Type: Outpatient Service (822) PRU: 52933 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11962_Housin.pdf
Housing Works, Inc. as Sponsor, Housing Works Health Services III, Inc. d/b/a Housing Works Community Healt Provider Number: 48960 Mr. Charles A. King, Chief Executive Officer Telephone - (347)-473-7407 Ext 7401 Administrative Office: 57 Willoughby Street, Brooklyn, NY 11201
Certificate Number: 230911997 Renewal Effective: 10/01/2020 Anticipated Recert Review: 9/30/2023 Program Location: Basement & 1st Floor, 2640 Pitkin Avenue, , Brooklyn, New York 11208 Service Type: Outpatient Service (822) PRU: 52958 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11997_Housin.pdf
Hudson River Healthcare, Inc. d/b/a Sun River Health Provider Number: 34370 Ms. Anne K. Nolon MPH, President and Chief Telephone - (914)-734-8600 Administrative Office: Executive Officer 1037 Main Street, Peekskill, NY 10566
Certificate Number: 230110933 Amendment Effective: 10/06/2020 Anticipated Recert Review: 1/31/2023 Program Location: Peekskill Area Health Center, Rooms 226 - 234, Basement & 2nd Floor, 1037 Main Street, Peekskill, New York 10566 Service Type: Outpatient Service (822) PRU: 50979 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10933_Hudson.pdf
Certificate Number: 221112171 Amendment Effective: 10/06/2020 Anticipated Recert Review: 11/30/2022 Program Location: 2400 Linden Boulevard, , Brooklyn, New York 11208 Service Type: Outpatient Service (822) PRU: 53298 Certified Capacity: with Telepractice Designation
Program Name: Alpha School 822 Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12171_Hudson.pdf
September 21, 2021 Page 104 of 225 Certificate Number: 211212172 Amendment Effective: 10/06/2020 Anticipated Recert Review: 12/31/2021 Program Location: 6th Floor, 56 Bay Street, , Staten Island, New York 10301 Service Type: Outpatient Service (822) PRU: 53300 Certified Capacity: 0 with Telepractice Designation
Program Name: Bay Street 822 Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12172_Hudson.pdf
Huntington Youth Bureau Youth Development Research Institute, Inc. Provider Number: 172 Ms. Maria Georgiou, Executive Director Telephone - (631)-351-3061 Administrative Office: 2nd Floor, 423 Park Avenue, Huntington, NY 11743
Certificate Number: 220811518 Amendment Effective: 07/03/2020 Anticipated Recert Review: 8/31/2022 Program Location: 3rd Floor, 423 Park Avenue, Huntington, New York 11743 Service Type: Outpatient Service (822) PRU: 992 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11518_Huntin.pdf
Huther-Doyle Memorial Institute, Inc. Provider Number: 32707 Ms. Kelly Reed, President/CEO Telephone - (585)-325-5100 Ext 3501 Administrative Office: 360 East Avenue, Rochester, NY 14604
Certificate Number: 221110827 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2022 Program Location: 1st & 2nd Floors, 360 East Avenue, Rochester, New York 14604 Service Type: Outpatient Service (822) PRU: 6013 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services
Program Name: Discovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10827_Huther.pdf
Ibero-American Action League, Inc. Provider Number: 21250 Ms. Angelica Perez-Delgado, CEO Telephone - (585)-256-8900 Ext 632 Administrative Office: 2nd Floor, 214 Clifford Avenue, Rochester, NY 14621
Certificate Number: 220111795 Amendment Effective: 10/12/2020 Anticipated Recert Review: 1/31/2022 Program Location: 2nd Floor, 214 Clifford Avenue, , Rochester, New York 14621 Service Type: Prevention Counseling PRU: 90851 Certified Capacity: 0
Program Name:
Edison Career & Tech High School, 1st Floor, Room #2C34, 655 Colfax Street , Rochester, NY 14606 Other Service Site(s) At: James Monroe High School, Basement, Room 32, 164 Alexander Street, Rochester, NY 14607 Other Service Site(s) At: Enrico Fermi School #17, 158 Orchard Street, Rochester, NY 14611 Other Service Site(s) At:
September 21, 2021 Page 105 of 225 East High School, 1801 Main Street, Rochester, NY 14609 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11795_IberoA.pdf
Immigrant Social Services, Inc. Provider Number: 889 Ms. Beatrice Chen, Executive Director Telephone - (212)-571-1840 Ext 100 Administrative Office: 137 Henry Street, New York, NY 10002
Certificate Number: 230211974 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/28/2023 Program Location: Basement, 1st & 2nd Floor, 137 Henry Street, New York, New York 10002 Service Type: Prevention Counseling PRU: 90744 Certified Capacity:
Program Name:
P.S. 2, Room 101B, 122 Henry Street, New York, NY 10002 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11974_Immigr.pdf
Innovative Health Systems, Inc. Provider Number: 32417 Mr. Abe Hikind, CEO Telephone - (914)-683-8050 Administrative Office: 2nd Floor, 20 Church Street, White Plains, NY 10601
Certificate Number: 210610830 Amendment Effective: 07/03/2020 Anticipated Recert Review: 6/30/2021 Program Location: 2nd Floor, 20 Church Street, White Plains, New York 10601 Service Type: Outpatient Service (822) PRU: 50978 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 52247 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10830_Innova.pdf
Interborough Developmental and Consultation Center, Inc. d/b/a LSA Recovery (IDCC) Provider Number: 15410 Stephen Gersten Psy.D., CEO Telephone - (929)-273-7601 Ext 427 Administrative Office: 1623 Kings Highway, Brooklyn, NY 11229
Certificate Number: 211212253 Establishment Effective: 01/07/2021 Anticipated Recert Review: 12/31/2021 Program Location: 1664 East 14th Street, , Brooklyn, New York 11229 Service Type: Outpatient Service (822) PRU: 53511 Certified Capacity: with Telepractice Designation
Program Name:
6th & 7th Floors, 2846 Stillwell Avenue, Brooklyn, NY 11224 Additional Location(s) At: 1117 Eastern Parkway, Brooklyn, NY 11213 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12253_Interb.pdf
September 21, 2021 Page 106 of 225 Inter-Care LTD. Provider Number: 16640 Mr. Nicholas Lessa, Chief Executive Officer Telephone - (914)-437-6800 Ext 212 Administrative Office: 7 West Cross Street, Hawthorne, NY 10532
Certificate Number: 211110833 Amendment Effective: 05/11/2020 Anticipated Recert Review: 11/30/2021 Program Location: Basement Level, 51 East 25th Street, New York, New York 10010 Service Type: Outpatient Service (822) PRU: 51154 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10833_InterC.pdf
Certificate Number: 211111882 Amendment Effective: 05/11/2020 Anticipated Recert Review: 11/30/2021 Program Location: 1st Floor, 5-7 West Cross Street, , Hawthorne, New York 10532 Service Type: Outpatient Service (822) PRU: 52852 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11882_InterC.pdf
Inwood Community Services, Inc. Provider Number: 31470 Charles Corliss Ph.D., Executive Director Telephone - (212)-942-0043 Ext 133 Administrative Office: 3rd Floor, 651 Academy Street, New York, NY 10034
Certificate Number: 220810836 Amendment Effective: 09/09/2020 Anticipated Recert Review: 8/31/2022 Program Location: 2nd and 3rd Floors, 651 Academy Street, New York, New York 10034 Service Type: Outpatient Service (822) PRU: 50985 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10836_Inwood.pdf
Ithaca Alpha House Center, Inc. d/b/a Cayuga Addiction Recovery Services Provider Number: 10930 Ms. Jessica Janssen, CEO Telephone - (315)-730-4634 Administrative Office: 334 West State Street, P.O. Box 789, Ithaca, NY 14850
Certificate Number: 201110837 Amendment Effective: 08/21/2020 Anticipated Recert Review: 11/30/2020 Program Location: 334 West State Street, , Ithaca, New York 14850 Service Type: Outpatient Service (822) PRU: 51478 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10837_Ithaca.pdf
September 21, 2021 Page 107 of 225 Certificate Number: 190812037 Renewal Effective: 09/01/2018 Anticipated Recert Review: 8/31/2019 Program Location: 6621 Route 227, Trumansburg, New York 14886 Service Type: Residential Services (820) PRU: 53017 Certified Capacity: 60 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12037_Ithaca.pdf
Certificate Number: 230912202 Renewal Effective: 10/01/2020 Anticipated Recert Review: 9/30/2023 Program Location: 334 West State Street, , Ithaca, New York 14850 Service Type: Opioid Treatment Program (822) PRU: 53341 Certified Capacity: 50 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12202_Ithaca.pdf
JCTOD Outreach, Inc. d/b/a Johnson Park Center Provider Number: 48430 RevDr Maria A. Scates D.D., CEO/Founder Telephone - (315)-734-9608 Administrative Office: 26 Johnson Park, P.O. Box 160, Utica, NY 13503
Certificate Number: 181211807 Conditional Certificate Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 19 Johnson Park, Utica, New York 13501 Service Type: Supportive Living (819) PRU: 52694 Certified Capacity: 6 and up to 14 beds for children Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11807_JCTODO.pdf
The Joan and Sanford I. Weill Medical College of Cornell University Provider Number: 43750 Mr. Gerard Ilaria, Executive Director Telephone - (212)-746-5917 Administrative Office: Department of Public Health Programs Administration, Room 3-305, 25th, 641 Lexington Avenue, New York, NY 10022
Certificate Number: 231111059 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: 9th Floor, 56 West 45th Street, New York, New York 10036 Service Type: Outpatient Service (822) PRU: 6098 Certified Capacity: with Telepractice Designation
Program Name: Midtown Center for Treatment and Research
6th Floor, Room 650, 53 West 23rd Street, New York, NY 10011 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11059_Joanan.pdf
Lafayette Medical Approach, LLC Provider Number: 45580 Mr Robert Degiarde, Executive Director Telephone - (212)-226-6263 Administrative Office: 233-235 Lafayette Street, New York, NY 10012
September 21, 2021 Page 108 of 225 Certificate Number: 230111804 Amendment Effective: 09/01/2020 Anticipated Recert Review: 1/31/2023 Program Location: 1st & 2nd Floors, 233-235 Lafayette Street, New York, New York 10012 Service Type: Opioid Treatment Program (822) PRU: 52692 Certified Capacity: 600 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11804_Lafaye.pdf
Larchmont-Mamaroneck Narcotics Guidance Council Provider Number: 447 Mark Levy Ph.D., Executive Director Telephone - (914)-698-7549 Administrative Office: 234 Stanley Avenue, Mamaroneck, NY 10543
Certificate Number: 240412000 Amendment Effective: 08/10/2021 Anticipated Recert Review: 4/30/2024 Program Location: 1st Floor, 234 Stanley Avenue, Mamaroneck, New York 10543 Service Type: Prevention Counseling PRU: 90588 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12000_Larchm.pdf
LaSalle School Provider Number: 12400 Mr. David C. Wallace, Chief Executive Officer Telephone - (518)-242-4731 Ext 218 Administrative Office: 391 Western Avenue, Albany, NY 12203
Certificate Number: 240110842 Renewal OMH Host Effective: 02/01/2021 Anticipated Recert Review: 1/31/2024 Program Location: Admin. Building, Burke Hall, Hanner Chapel, Cultural Center, Gym, Cafeteria, & Lobby Conference, 391 Western Avenue, Rooms 101, 204, 205 & 206, Albany, New York 12203 Service Type: Outpatient Service (822) PRU: 5469 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10842_LaSall.pdf
Lesbian and Gay Community Services Center Inc. Provider Number: 31450 Ms. Glennda Testone, Executive Director Telephone - (212)-620-7310 Ext 419 Administrative Office: 208 West 13th Street, New York, NY 10011
Certificate Number: 220711628 Renewal Effective: 09/04/2020 Anticipated Recert Review: 7/31/2022 Program Location: 1st Floor, 208 West 13th Street, New York, New York 10011 Service Type: Outpatient Service (822) PRU: 52109 Certified Capacity: with Telepractice Designation
Program Name: Center CARE Recovery Service Type: Outpatient Service (822) PRU: 52950 Certified Capacity: with Telepractice Designation
Program Name: Center CARE Recovery
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11628_Lesbia.pdf
September 21, 2021 Page 109 of 225 Certificate Number: 230211972 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/28/2023 Program Location: Annex, 208 West 13th Street, New York, New York 10011 Service Type: Prevention Counseling PRU: 90778 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11972_Lesbia.pdf
Lexington Center for Recovery, Inc. Provider Number: 34200 Adrienne Marcus Ph.D., Chief Executive Officer Telephone - (914)-666-0191 Ext 1006 Administrative Office: 2875 Route 35, Katonah, NY 10536
Certificate Number: 230710575 Renewal Effective: 08/01/2021 Anticipated Recert Review: 7/31/2023 Program Location: 24 Smith Avenue, Mount Kisco, New York 10549 Service Type: Outpatient Service (822) PRU: 50818 Certified Capacity: [with ancillary withdrawal services] with Telepractice Designation
Program Name: Mount Kisco Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10575_Lexing.pdf
Certificate Number: 210911340 Amendment Effective: 02/11/2019 Anticipated Recert Review: 9/30/2021 Program Location: 41 Page Park Drive, , Poughkeepsie, New York 12603 Service Type: Outpatient Service (822) PRU: 50577 Certified Capacity: 0 with Telepractice Designation
Program Name:
Dover High School, 2368 Route 22, Dover Plains, NY 12522 Additional Location(s) At: 3rd Floor, 135 County House Road, Millbrook, NY 12545 Additional Location(s) At: Suite 2, 7 Dover Village Plaza, Dover Plains, NY 12522 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11340_Lexing.pdf
Certificate Number: 231111341 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: Summerlin Plaza, Suites 201-204, 942 Route 376, Wappingers Falls, New York 12590 Service Type: Outpatient Service (822) PRU: 51777 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11341_Lexing.pdf
September 21, 2021 Page 110 of 225 Certificate Number: 240511461 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2024 Program Location: 2nd Floor, 3 Cottage Place, , New Rochelle, New York 10801 Service Type: Outpatient Service (822) PRU: 50386 Certified Capacity: 0 with Telepractice and Problem Gambling Designations
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51940 Certified Capacity: with Telepractice and Problem Gambling Designations
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11461_Lexing.pdf
Certificate Number: 230211477 Amendment Effective: 08/04/2020 Anticipated Recert Review: 2/28/2023 Program Location: Suite 200, 41 Page Park Drive, , Poughkeepsie, New York 12603 Service Type: Opioid Treatment Program (822) PRU: 391 Certified Capacity: 300 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11477_Lexing.pdf
Certificate Number: 230211641 Amendment Effective: 08/09/2021 Anticipated Recert Review: 2/28/2023 Program Location: Suite 111, 100 Route 59, , Airmont, New York 10952 Service Type: Outpatient Service (822) PRU: 52137 Certified Capacity: with Telepractice and Problem Gambling Designations
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 52140 Certified Capacity: with Telepractice and Problem Gambling Designations
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11641_Lexing.pdf
Certificate Number: 230111727 Amendment Effective: 07/03/2020 Anticipated Recert Review: 1/31/2023 Program Location: Samsondale Shopping Plaza, 45 South Route 9W, , West Haverstraw, New York 10993 Service Type: Outpatient Service (822) PRU: 52154 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11727_Lexing.pdf
Certificate Number: 210311755 Renewal Effective: 04/01/2019 Anticipated Recert Review: 3/31/2021 Program Location: 2nd Floor, 412 Main Street, , Poughkeepsie, New York 12601 Service Type: Outpatient Service (822) PRU: 52586 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11755_Lexing.pdf
September 21, 2021 Page 111 of 225 Certificate Number: 231111794 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: Suite D, 706 Executive Boulevard, Valley Cottage, New York 10989 Service Type: Opioid Treatment Program (822) PRU: 52646 Certified Capacity: 250 with Telepractice Designation Capacity Lifted Program Name: Rockland Medication Assisted Treatment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11794_Lexing.pdf
Certificate Number: 221011862 Renewal Effective: 11/01/2019 Anticipated Recert Review: 10/31/2022 Program Location: 3 Corporate Drive, , Peekskill, New York 10566 Service Type: Opioid Full Agonist Treatment Program (822) PRU: 52801 Certified Capacity: 235 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11862_Lexing.pdf
Certificate Number: 211111883 Amendment Effective: 09/19/2019 Anticipated Recert Review: 11/30/2021 Program Location: 3 Corporate Drive, , Peekskill, New York 10566 Service Type: Outpatient Service (822) PRU: 52800 Certified Capacity: 0 with Telepractice Designation
Program Name: LCR Peekskill Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11883_Lexing.pdf
Liberty Resources, Inc. Provider Number: 50660 Mr. Carl M. Coyle, Chief Executive Officer Telephone - (315)-425-1004 Ext 255 Administrative Office: Suite 200, 6723 Towpath Road, East Syracuse, NY 13507
Certificate Number: 190710205 Amendment Effective: 04/25/2019 Anticipated Recert Review: 7/31/2019 Program Location: 239 Broad Street, Oneida, New York 13421 Service Type: Supportive Living (819) PRU: 51601 Certified Capacity: 30
Program Name: The Next Step Apartment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10205_Libert.pdf
Certificate Number: 181210206 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 239 Broad Street, Oneida, New York 13421 Service Type: Community Residential (819) PRU: 51121 Certified Capacity: 18
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10206_Libert.pdf
September 21, 2021 Page 112 of 225 Certificate Number: 200912206 Establishment Effective: 10/07/2019 Anticipated Recert Review: 9/30/2020 Program Location: 1045 James Street, , Syracuse, New York 13203 Service Type: Outpatient Service (822) PRU: 53457 Certified Capacity: with Telepractice Designation
Program Name: Liberty Resources Integrated Health Care
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12206_Libert.pdf
Long Beach Reach, Inc. Provider Number: 190 Joseph M. Smith Ph.D., Executive Director Telephone - (516)-889-2332 Administrative Office: Suite 200, 3rd Floor, 2-12 West Park Avenue, Long Beach, NY 11561
Certificate Number: 220910851 Renewal Effective: 10/01/2020 Anticipated Recert Review: 9/30/2022 Program Location: 2nd & 3rd Floors, 2-12 West Park Avenue, Long Beach, New York 11561 Service Type: Outpatient Service (822) PRU: 7051 Certified Capacity: with Telepractice Designation
Program Name:
Suite 106, 340 Dogwood Avenue, Franklin Square, NY 11010 Additional Location(s) At: 2nd Floor, 165 East Park Avenue, Long Beach, NY 11561 Additional Location(s) At: 225 Main Street, Port Washington, NY 11050 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10851_LongBe.pdf
Long Island Center for Recovery, Inc. Provider Number: 25850 Ms. Shawn Hamilton, Chief Executive Officer Telephone - (631)-728-3100 Administrative Office: 320 West Montauk Highway, Hampton Bays, NY 11946
Certificate Number: 220710071 Renewal Effective: 08/01/2019 Anticipated Recert Review: 7/31/2022 Program Location: 320 West Montauk Highway, Hampton Bays, New York 11946 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 51759 Certified Capacity: 10
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10071_LongIs.pdf
Certificate Number: 240411373 Renewal Effective: 05/01/2021 Anticipated Recert Review: 4/30/2024 Program Location: 320 West Montauk Highway, Hampton Bays, New York 11946 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51713 Certified Capacity: 40
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11373_LongIs.pdf
September 21, 2021 Page 113 of 225 Long Island Consultation Center, Inc. Provider Number: 16190 Ms. Elaine Lederer, Executive Director Telephone - (718)-896-3400 Ext 118 Administrative Office: Suite 222, 2nd Floor, 91-31 Queens Boulevard, Elmhurst, NY 11373
Certificate Number: 240410852 Renewal Effective: 05/01/2021 Anticipated Recert Review: 4/30/2024 Program Location: 2nd Floor, 91-31 Queens Boulevard, Elmhurst, New York 11373 Service Type: Outpatient Service (822) PRU: 50330 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10852_LongIs.pdf
The Lower East Side Service Center, Inc. Provider Number: 23720 Ms. Valerie C. Walters, President and Chief Telephone - (212)-566-7719 Administrative Office: Executive Officer Suite 305, 3rd Floor, 80 Maiden Lane, New York, NY 10038
Certificate Number: 211110360 Amendment Effective: 07/10/2020 Anticipated Recert Review: 11/30/2021 Program Location: 1st, 2nd, 4th and 5th Floors, 46 East Broadway, New York, New York 10002 Service Type: Opioid Treatment Program (822) PRU: 644 Certified Capacity: 490 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10360_LowerE.pdf
Certificate Number: 211210361 Conditional Certificate Effective: 01/01/2021 Anticipated Recert Review: 12/31/2021 Program Location: 46 East Broadway (4th & 5th Floors), 62 East Broadway (1st & 2nd Floors), New York, New York 10002 Service Type: Opioid Treatment Program (822) PRU: 646 Certified Capacity: 380 with Telepractice Designation
Program Name: Clinic III
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10361_LowerE.pdf
Certificate Number: 211110362 Conditional Certificate Effective: 06/01/2021 Anticipated Recert Review: 11/30/2021 Program Location: 7 Gouverneur Slip East, New York, New York 10002 Service Type: Residential Opioid Treatment Program (822) PRU: 311 Certified Capacity: 100 [for PRU #52063 only] with Telepractice Designation
Program Name: Service Type: Residential Opioid Treatment Program (822) PRU: 3096 Certified Capacity: 43 [for PRU #52063 only] with Telepractice Designation
Program Name: Service Type: Residential Opioid Treatment Program (822) PRU: 52063 Certified Capacity: 10 [for PRU #52063 only] with Telepractice Designation and up to 8 beds for children Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10362_LowerE.pdf
September 21, 2021 Page 114 of 225 Certificate Number: 210511062 Amendment Effective: 07/10/2020 Anticipated Recert Review: 5/31/2021 Program Location: 4th - 7th Floors, 46 East Broadway, New York, New York 10002 Service Type: Outpatient Service (822) PRU: 7294 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11062_LowerE.pdf
LSCA Group, Inc. as Sponsor, BestSelf Behavioral Health, Inc as Operator Provider Number: 50250 Howard K. Hitzel PsyD, President Telephone - (716)-842-0440 Ext 112 Administrative Office: Suite 300, 255 Delaware Avenue, Buffalo, NY 14202
Certificate Number: 210712081 Renewal OMH Host Effective: 08/01/2018 Anticipated Recert Review: 7/31/2021 Program Location: 3176 Abbott Road, , Orchard Park, New York 14127 Service Type: Outpatient Service (822) PRU: 53114 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Abbott Corners Addiction Services
2101 Spruce Street, North Collins, NY 14111 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12081_LSCAGr.pdf
Certificate Number: 180512083 Special ReIssue OMH Host Effective: 01/01/2018 Anticipated Recert Review: 5/31/2018 Program Location: 1st and 2nd Floors, 951-955 Niagara Street, Buffalo, New York 14213 Service Type: Outpatient Service (822) PRU: 53113 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Lower West Side Addictions Services
2nd Floor, 254 Franklin Street, Buffalo, NY 14202 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12083_LSCAGr.pdf
Certificate Number: 220912162 Amendment Effective: 02/03/2020 Anticipated Recert Review: 9/30/2022 Program Location: 3176 Abbott Road, , Orchard Park, New York 14127 Service Type: Opioid Treatment Program (822) PRU: 53276 Certified Capacity: 99 Capacity Lifted Program Name: Abbott Corners Addiction Services OTP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12162_LSCAGr.pdf
Certificate Number: 210812191 Establishment Effective: 09/01/2020 Anticipated Recert Review: 8/31/2021 Program Location: 1st & 2nd Floors, 232-262 Hempstead Avenue, , Buffalo, New York 14215 Service Type: Residential Services (820) PRU: 53458 Certified Capacity: 22 with Telepractice Designation and up to 30 beds for children Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: The Lighthouse -Women's Residential Treatment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12191_LSCAGr.pdf
September 21, 2021 Page 115 of 225 Medical Arts Sanitarium, Inc. Provider Number: 81770 Mr. Thomas Puzo, Chief Executive Officer Telephone - (718)-906-6700 Ext 3103 Administrative Office: 159-05 Union Turnpike, Fresh Meadows, NY 11366 d/b/a Cornerstone of Rhinebeck Certificate Number: 221010239 Renewal Effective: 11/01/2019 Anticipated Recert Review: 10/31/2022 Program Location: Rhinebeck Lodge, Building 1, 2nd Floor, 500 Milan Hollow Road, Rhinebeck, New York 12572 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50486 Certified Capacity: 93 for adults - with the use of methadone [up to 13 of these beds, in Rm 114-117, may be used for the provision of medically supervised inpatient withdrawal & stabilization services, as needed.]
Program Name: Cornerstone of Rhinebeck, NY
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10239_Medica.pdf d/b/a Cornerstone of Medical Arts Center Certificate Number: 221010241 Amendment Effective: 11/24/2020 Anticipated Recert Review: 10/31/2022 Program Location: 2nd Floors, Basement, 1st &, 159-05 Union Turnpike, Fresh Meadows, New York 11366 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51379 Certified Capacity: 60 for adults - with the use of methadone [up to 58 of these beds may be used for the provision of medically supervised inpatient withdrawal & stabilization services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10241_Medica.pdf d/b/a Cornerstone of Rhinebeck Certificate Number: 221111438 Renewal Effective: 12/01/2019 Anticipated Recert Review: 11/1/2022 Program Location: Rhinebeck Lodge, Building 1, Ground Floor, 500 Milan Hollow Road, Rhinebeck, New York 12572 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 7163 Certified Capacity: 6 for adults - with the use of methadone [up to 3 of these beds, in Room #114, may be used for the provision of inpatient rehabilitation services, as needed.]
Program Name: Cornerstone of Rhinebeck, NY
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11438_Medica.pdf d/b/a Cornerstone of Medical Arts Center Certificate Number: 221111440 Amendment Effective: 11/24/2020 Anticipated Recert Review: 11/30/2022 Program Location: 4th Floors, Basement, 3rd &, 159-05 Union Turnpike, Fresh Meadows, New York 11366 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 9 Certified Capacity: 116 for adults - with the use of methadone [up to 58 of these beds may be used for the provision of inpatient rehabilitation services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11440_Medica.pdf
Mental Health America of Dutchess County, Inc. as Sponsor, Mid-Hudson Addiction Recovery Centers, Inc. as O Provider Number: 34010 Mr. Andrew O'Grady, CEO Telephone - (845)-473-2500 Administrative Office: 253 Mansion Street, Poughkeepsie, NY 12601
September 21, 2021 Page 116 of 225 Certificate Number: 191010111 Establishment Effective: 11/29/2018 Anticipated Recert Review: 10/31/2019 Program Location: Route 376, 2103 New Hackensack Road, Poughkeepsie, New York 12603 Service Type: Community Residential (819) PRU: 51228 Certified Capacity: 12
Program Name: Dowling House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10111_Mental.pdf
Certificate Number: 191010112 Establishment Effective: 11/29/2018 Anticipated Recert Review: 10/31/2019 Program Location: 230 Church Street, Poughkeepsie, New York 12601 Service Type: Community Residential (819) PRU: 50507 Certified Capacity: 24
Program Name: Bolger House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10112_Mental.pdf
Certificate Number: 191010113 Establishment Effective: 11/29/2018 Anticipated Recert Review: 10/31/2019 Program Location: 24 West Cottage Road, Poughkeepsie, New York 12601 Service Type: Community Residential (819) PRU: 50506 Certified Capacity: 24
Program Name: Florence Manor
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10113_Mental.pdf
Certificate Number: 191010114 Establishment Effective: 11/29/2018 Anticipated Recert Review: 10/31/2019 Program Location: 1st Floor, 51 Cannon Street, Poughkeepsie, New York 12601 Service Type: Medically Monitored Withdrawal & Stabilization Services (816.9) PRU: 50508 Certified Capacity: 12
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10114_Mental.pdf
Mental Health Association in Fulton and Montgomery Counties, Inc. Provider Number: 24020 Ms. Janine Dykeman, Executive Director Telephone - (518)-762-5332 Administrative Office: 307-309 Meadow Street, Johnstown, NY 12095
Certificate Number: 181211773 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 26 Phillips Street, Amsterdam, New York 12010 Service Type: Community Residential (819) PRU: 52620 Certified Capacity: 12 and up to 6 beds for children Program Name: Lighthouse
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11773_Mental.pdf
Mental Health Providers of Western Queens, Inc. Provider Number: 16140 James T. McQuade Ph.D., Executive Director Telephone - (718)-898-5085 Administrative Office: 2nd Floor, 40-23 62nd Street, Woodside, NY 11377
September 21, 2021 Page 117 of 225 Certificate Number: 210910867 Amendment Effective: 07/10/2020 Anticipated Recert Review: 9/30/2021 Program Location: 4th Floor, 62-07 Woodside Avenue, Woodside, New York 11377 Service Type: Outpatient Service (822) PRU: 51264 Certified Capacity: with Telepractice Designation
Program Name:
William Cullen Bryant High School, 48-10 31st Avenue, Long Island City, NY 11103 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10867_Mental.pdf
Certificate Number: 240312041 Amendment Effective: 08/10/2021 Anticipated Recert Review: 3/31/2024 Program Location: Suite 2A, 2nd Floor, 37-08 91st Street, Jackson Heights, New York 11372 Service Type: Prevention Counseling PRU: 90863 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12041_Mental.pdf
Mental Health Services - Erie County South East Corporation V d/b/a Spectrum Human Services Provider Number: 50240 Mr. Bruce C. Nisbet, Chief Executive Officer Telephone - (716)-662-2040 Administrative Office: 227 Thorn Avenue, P.O. Box 631, Orchard Park, NY 14127
Certificate Number: 210910870 Amendment OMH Host Effective: 09/09/2021 Anticipated Recert Review: 9/30/2021 Program Location: 2412 Seneca Street, , Buffalo, New York 14210 Service Type: Outpatient Service (822) PRU: 50394 Certified Capacity:
Program Name: South Buffalo Counseling Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10870_Mental.pdf
Certificate Number: 210910871 Amendment/Renewal OMH Host Effective: 06/01/2019 Anticipated Recert Review: 9/30/2021 Program Location: 326 Orchard Park Road, , West Seneca, New York 14224 Service Type: Outpatient Service (822) PRU: 50393 Certified Capacity:
Program Name:
27 Franklin Street, Springville, NY 14141 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10871_Mental.pdf
Certificate Number: 210911522 Amendment OMH Host Effective: 07/30/2021 Anticipated Recert Review: 9/30/2021 Program Location: 1280 Main Street, , Buffalo, New York 14209 Service Type: Outpatient Service (822) PRU: 5119 Certified Capacity: [with ancillary withdrawal services] with Telepractice Designation
Program Name: New Alternatives
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11522_Mental.pdf
September 21, 2021 Page 118 of 225 Certificate Number: 210911751 Amendment OMH Host Effective: 06/01/2019 Anticipated Recert Review: 9/30/2021 Program Location: 34 North Main Street, , Warsaw, New York 14569 Service Type: Outpatient Service (822) PRU: 52581 Certified Capacity: [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11751_Mental.pdf
Mercy Medical Center Provider Number: 85030 Mr. Peter Scaminaci, President Telephone - (516)-705-1100 Administrative Office: 1000 North Village Avenue, Rockville Centre, NY 11570
Certificate Number: 240110608 Amendment OMH Host Effective: 08/10/2021 Anticipated Recert Review: 1/31/2024 Program Location: 506 Stewart Avenue, Garden City, New York 11530 Service Type: Outpatient Service (822) PRU: 50360 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Mercy Hospital Family Counseling Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10608_MercyM.pdf
Certificate Number: 220212244 Establishment Effective: 03/01/2021 Anticipated Recert Review: 2/28/2022 Program Location: 95 Pine Street, , Freeport, New York 11520 Service Type: Residential Services (820) PRU: 53525 Certified Capacity: 22
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Mercy Hall
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12244_MercyM.pdf
Certificate Number: 220212245 Establishment Effective: 03/01/2021 Anticipated Recert Review: 2/28/2022 Program Location: 526 Greengrove Avenue, , Uniondale, New York 11553 Service Type: Residential Services (820) PRU: 53526 Certified Capacity: 22
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Recovery House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12245_MercyM.pdf
Certificate Number: 220212246 Establishment Effective: 03/01/2021 Anticipated Recert Review: 2/28/2022 Program Location: 150 Buffalo Avenue, , Freeport, New York 11520 Service Type: Residential Services (820) PRU: 53527 Certified Capacity: 30
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: New Hope
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12246_MercyM.pdf
Metropolitan Center for Mental Health Provider Number: 16130 Mr. Robert Basile, Executive Director Telephone - (212)-362-8755 Administrative Office: 160 West 86th Street, New York, NY 10024
September 21, 2021 Page 119 of 225 Certificate Number: 220111330 Amendment Effective: 08/25/2020 Anticipated Recert Review: 1/31/2022 Program Location: Basement, 1090 St. Nicholas Avenue, New York, New York 10033 Service Type: Outpatient Service (822) PRU: 51729 Certified Capacity: with Telepractice Designation
Program Name: Families and Individuals in Recovery (FAIR)
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11330_Metrop.pdf
Metropolitan Community Services, Inc. d/b/a Journeys Provider Number: 49320 Rabbi Sinai Halberstam, CEO Telephone - (718)-633-5328 Administrative Office: 1049 38th Street, Brooklyn, NY 11219
Certificate Number: 230511996 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2023 Program Location: 1049 38th Street, Brooklyn, New York 11219 Service Type: Outpatient Service (822) PRU: 52957 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11996_Metrop.pdf
Mid-Erie Mental Health Services, Inc. d/b/a Endeavor Health Services Provider Number: 50230 Ms. Elizabeth Mauro, Executive Director Telephone - (716)-895-6700 Ext 4051 Administrative Office: Suite 400, 1st Floor, 1526 Walden Avenue, Cheektowaga, NY 14225
Certificate Number: 220110875 Amendment OMH Host Effective: 05/28/2020 Anticipated Recert Review: 1/31/2022 Program Location: Suite 400, 1526 Walden Avenue, Cheektowaga, New York 14225 Service Type: Outpatient Service (822) PRU: 50357 Certified Capacity: withTelepractice Designation [with ancillary withdrawal services]
Program Name:
Gateway-Longview, Inc. - Lynde School, Conference Room and Room 61, 6350 Main Street, Williamsville, NY 14221 Additional Location(s) At: 463 William Street, Buffalo, NY 14204 Additional Location(s) At: Baker Victory Services Residential Treatment Facility-Admin. Bldg., 1st Floor, Conference Room/Counseling Office, 125 Martin Road, Lackawanna, NY 14218 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10875_MidEri.pdf
Certificate Number: 220110876 Amendment OMH Host Effective: 05/28/2020 Anticipated Recert Review: 1/31/2022 Program Location: 2nd Floor, 1131 Broadway, Buffalo, New York 14212 Service Type: Outpatient Service (822) PRU: 6428 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10876_MidEri.pdf
September 21, 2021 Page 120 of 225 MIH Experience, LTD Provider Number: 48730 Fernando Taveras M.D., Executive Director Telephone - (212)-928-2020 Administrative Office: 1st Floor, 4580 Broadway, New York, NY 10040
Certificate Number: 210511982 Amendment Effective: 11/19/2020 Anticipated Recert Review: 5/31/2021 Program Location: 1st Floor, 4580 Broadway, , New York, New York 10040 Service Type: Outpatient Service (822) PRU: 52945 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11982_MIHExp.pdf
The Monsignor Carr Institute Provider Number: 24680 Mr. Dennis Walczyk, Chief Executive Officer Telephone - (716)-218-1400 Ext 244 Administrative Office: Administrative Offices, 741 Delaware Avenue, Buffalo, NY 14209
Certificate Number: 220811063 Amendment Effective: 09/01/2020 Anticipated Recert Review: 8/31/2022 Program Location: Annex, 1st and 2nd Floors, 76 West Humboldt Parkway, Buffalo, New York 14214 Service Type: Outpatient Service (822) PRU: 5595 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11063_Monsig.pdf
Montefiore Health System, Inc. as Sponsor Montefiore Mount Vernon Hospital as Operator Provider Number: 80000 Ms. Jaccel Kouns, Executive Director/V.P. of Clinical Telephone - (914)-631-6100 Administrative Office: Services Montefiore Mount Vernon Hospital as Operator, Building #111, 12 N 7th Avenue, Mount Vernon, NY 10550
Certificate Number: 210911813 Amendment Effective: 09/09/2020 Anticipated Recert Review: 9/30/2021 Program Location: 3 South Sixth Avenue, Mount Vernon, New York 10550 Service Type: Opioid Treatment Program (822) PRU: 52719 Certified Capacity: 400 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11813_Montef.pdf
Montefiore Medical Center Provider Number: 85420 Mr. Juan Martinez LCSW, Executive Director Telephone - (718)-409-9450 Administrative Office: Executive Suite, 1510 Waters Place, Bronx, NY 10461
Certificate Number: 210410454 Amendment Effective: 08/03/2020 Anticipated Recert Review: 4/30/2021 Program Location: 1st & 2nd Floors, 2058 Jerome Avenue, Bronx, New York 10453 Service Type: Opioid Treatment Program (822) PRU: 420 Certified Capacity: 700 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10454_Montef.pdf
September 21, 2021 Page 121 of 225 Certificate Number: 231210455 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2023 Program Location: 1st Floor, 3550 Jerome Avenue, Bronx, New York 10467 Service Type: Opioid Treatment Program (822) PRU: 327 Certified Capacity: 350 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10455_Montef.pdf
Certificate Number: 201111462 Amendment Effective: 08/03/2020 Anticipated Recert Review: 11/30/2020 Program Location: 3rd Floor, 2058 Jerome Avenue, Bronx, New York 10453 Service Type: Outpatient Service (822) PRU: 51981 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11462_Montef.pdf
Certificate Number: 221011677 Amendment Effective: 08/05/2020 Anticipated Recert Review: 10/31/2022 Program Location: 1st & 2nd Floors, 4401 Bronx Boulevard, Bronx, New York 10470 Service Type: Outpatient Service (822) PRU: 52212 Certified Capacity: with Telepractice Designation
Program Name: Wakefield Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11677_Montef.pdf
Certificate Number: 210911871 Amendment Effective: 08/03/2020 Anticipated Recert Review: 9/30/2021 Program Location: 804 East 138th Street, , Bronx, New York 10454 Service Type: Opioid Treatment Program (822) PRU: 52790 Certified Capacity: 1080 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11871_Montef.pdf
Certificate Number: 190211872 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 2/28/2019 Program Location: 1510 Waters Place, Bronx, New York 10461 Service Type: Medically Supervised Outpatient Withdrawal & Stabilization (816.8) PRU: 52788 Certified Capacity: 15
Program Name: Outpatient Withdrawal
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11872_Montef.pdf
September 21, 2021 Page 122 of 225 Certificate Number: 231111873 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: 1510 Waters Place, Bronx, New York 10461 Service Type: Opioid Treatment Program (822) PRU: 52786 Certified Capacity: 995 with Telepractice Designation Capacity Lifted Program Name: Wellness Center at Waters Place Service Type: Opioid Medical Maintenance (822) PRU: 52789 Certified Capacity: Capacity Lifted Program Name: Wellness Center at Waters Place
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11873_Montef.pdf
Certificate Number: 221211874 Amendment Effective: 08/05/2020 Anticipated Recert Review: 12/31/2022 Program Location: Track Level, 260 East 161st Street, Bronx, New York 10451 Service Type: Opioid Treatment Program (822) PRU: 52791 Certified Capacity: 950 with Telepractice Designation
Program Name: Wellness Center at Melrose
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11874_Montef.pdf
Certificate Number: 240611875 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2024 Program Location: 1510 Waters Place, Bronx, New York 10461 Service Type: Outpatient Service (822) PRU: 52787 Certified Capacity: with Telepractice Designation
Program Name: Next Steps North Service Type: Outpatient Service (822) PRU: 52915 Certified Capacity: with Telepractice Designation
Program Name: Next Steps North
1200 Waters Place, Bronx, NY 10461 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11875_Montef.pdf
Certificate Number: 211211876 Amendment Effective: 08/05/2020 Anticipated Recert Review: 12/31/2021 Program Location: S-Level, 260 East 161st Street, , Bronx, New York 10451 Service Type: Outpatient Service (822) PRU: 52792 Certified Capacity: with Telepractice Designation
Program Name: Next Steps South
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11876_Montef.pdf
Montefiore Nyack Hospital Provider Number: 83100 Mark Geller M.D., President & CEO Telephone - (845)-348-2110 Administrative Office: 160 North Midland Avenue, Nyack, NY 10960
September 21, 2021 Page 123 of 225 Certificate Number: 190110257 Establishment Deemed Effective: 02/05/2018 Anticipated Recert Review: 1/31/2019 Program Location: Building B, 3rd Floor, 160 North Midland Avenue, Nyack, New York 10960 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 51030 Certified Capacity: 8 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10257_Montef.pdf
Certificate Number: 220111065 Amendment Effective: 07/02/2021 Anticipated Recert Review: 1/31/2022 Program Location: The Hub, 312 Route 59, , Central Nyack, New York 10960 Service Type: Outpatient Service (822) PRU: 51650 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11065_Montef.pdf
Certificate Number: 190111415 Establishment Deemed Effective: 02/05/2018 Anticipated Recert Review: 1/31/2019 Program Location: Building B, 3rd Floor, 160 North Midland Avenue, Nyack, New York 10960 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51031 Certified Capacity: 20 with Telepractice Designation
Program Name: The Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11415_Montef.pdf
Mount Sinai Hospitals Group, Inc. as Sponsor, Beth Israel Medical Center as Operator Provider Number: 83040 Dr Jeremy Boal M.D., President Telephone - (212)-420-2520 Administrative Office: 2 Dazian, First Ave. & 16th Street, New York, NY 10003
Certificate Number: 200712092 Amendment Deemed Effective: 06/05/2020 Anticipated Recert Review: 7/31/2020 Program Location: 1st and 2nd Floors, 26 Avenue A, New York, New York 10009 Service Type: Opioid Treatment Program (822) PRU: 53126 Certified Capacity: 400 with Telepractice Designation
Program Name: MMTP Avenue A Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12093_MountS.pdf
Certificate Number: 200712094 Amendment Deemed Effective: 06/05/2020 Anticipated Recert Review: 7/31/2020 Program Location: 1st and 2nd Floors, 109-11 Delancey Street, New York, New York 10002 Service Type: Opioid Treatment Program (822) PRU: 53125 Certified Capacity: 450 with Telepractice Designation Capacity Lifted Program Name: Gouverneur Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12094_MountS.pdf
September 21, 2021 Page 124 of 225 Certificate Number: 210712096 Amendment Deemed Effective: 06/05/2020 Anticipated Recert Review: 7/31/2021 Program Location: 2nd Floor, 25 12th Street, Brooklyn, New York 11215 Service Type: Opioid Treatment Program (822) PRU: 53131 Certified Capacity: 600 with Telepractice Designation Capacity Lifted Program Name: Vincent P. Dole Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12096_MountS.pdf
Certificate Number: 200712097 Renewal Deemed Effective: 08/01/2018 Anticipated Recert Review: 7/31/2020 Program Location: Bernstein Pavilion, 6th Floor, 1-9 Nathan D. Perlman Place, New York, New York 10003 Service Type: Medically Supervised Outpatient Withdrawal & Stabilization (816.8) PRU: 53139 Certified Capacity: 20 [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12097_MountS.pdf
Certificate Number: 200712098 Amendment Deemed Effective: 06/05/2020 Anticipated Recert Review: 7/31/2020 Program Location: 4th Floor, 103 East 125th Street, New York, New York 10035 Service Type: Opioid Treatment Program (822) PRU: 53129 Certified Capacity: 600 with Telepractice Designation Capacity Lifted Program Name: Harlem No. 2
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12098_MountS.pdf
Certificate Number: 210712099 Amendment Deemed Effective: 06/05/2020 Anticipated Recert Review: 7/31/2021 Program Location: 2nd Floor, 103 East 125th Street, New York, New York 10035 Service Type: Opioid Treatment Program (822) PRU: 53135 Certified Capacity: 450 with Telepractice Designation
Program Name: Harlem No. 6/7
3rd Floor, 103 East 125th Street, New York, NY 10035 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12099_MountS.pdf
Certificate Number: 210712100 Amendment Deemed Effective: 06/22/2020 Anticipated Recert Review: 7/31/2021 Program Location: Bernstein Pavilion, 6th Floor, 1-9 Nathan D. Perlman Place, New York, New York 10003 Service Type: Outpatient Service (822) PRU: 53137 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 53140 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12100_MountS.pdf
September 21, 2021 Page 125 of 225 Certificate Number: 210712103 Renewal Effective: 08/01/2018 Anticipated Recert Review: 7/31/2021 Program Location: Bernstein Pavilion, 3rd Floor, 10 Nathan D. Perlman Place, New York, New York 10003 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53136 Certified Capacity: 30
Program Name: Stuyvesant Square Chemical Dependency Treatment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12103_MountS.pdf
Certificate Number: 210712104 Amendment Deemed Effective: 06/05/2020 Anticipated Recert Review: 7/31/2021 Program Location: 6th Floor, 140 West 125th Street, New York, New York 10027 Service Type: Opioid Treatment Program (822) PRU: 53130 Certified Capacity: 800 with Telepractice Designation
Program Name: Clinic 8
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12104_MountS.pdf
Certificate Number: 210712105 Amendment Deemed Effective: 06/05/2020 Anticipated Recert Review: 7/31/2021 Program Location: 8th Floor, 103 East 125th Street, New York, New York 10035 Service Type: Opioid Treatment Program (822) PRU: 53128 Certified Capacity: 800 with Telepractice Designation
Program Name: Clinic 1
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12105_MountS.pdf
Certificate Number: 210712106 Amendment Effective: 06/28/2021 Anticipated Recert Review: 7/31/2021 Program Location: Bernstein Pavilion, 5th Floor, 1-9 Nathan D. Perlman Place, Pharmacy located on 16th Street and 1st Avenue, , New York, New York 10003 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 53138 Certified Capacity: 31 [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12106_MountS.pdf
Mount Sinai Hospitals Group, Inc. as Sponsor, The St. Luke’s Roosevelt Hospital Center, d/b/a Mount Sinai Mor Provider Number: 87090 Mr Arthur Gianelli, CEO Mount Sinai St. Luke's Telephone - (212)-523-4000 Administrative Office: Hospital 1111 Amsterdam Avenue, New York, NY 10025
September 21, 2021 Page 126 of 225 Certificate Number: 200812107 Amendment Effective: 02/04/2020 Anticipated Recert Review: 8/31/2020 Program Location: Winston Building , 9th Floor, 1000 Tenth Avenue, , New York, New York 10019 Service Type: Outpatient Service (822) PRU: 53143 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Service (822) PRU: 53144 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 53148 Certified Capacity: with Telepractice Designation
Program Name:
2nd Floor, 411 West 114th Street, New York, NY 10025 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12107_MountS.pdf
Certificate Number: 220412109 Amendment Effective: 09/01/2020 Anticipated Recert Review: 4/30/2022 Program Location: 306 West 102nd Street, New York, New York 10025 Service Type: Community Residential (819) PRU: 53146 Certified Capacity: 24 with Telepractice Designation
Program Name: St. Luke's Roosevelt Hospital Halfway House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12109_MountS.pdf
Certificate Number: 210712110 Amendment Deemed Effective: 09/01/2020 Anticipated Recert Review: 7/14/2021 Program Location: Winston Building, 8th Floor, 1000 Tenth Avenue, , New York, New York 10019 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 53141 Certified Capacity: 15 with Telepractice Designation [with the use of methadone] [up to 15 beds may be used for the provision of inpatient rehabilitation service as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12110_MountS.pdf
Certificate Number: 210712111 Amendment Deemed Effective: 09/01/2020 Anticipated Recert Review: 7/14/2021 Program Location: Winston Building, 8th Floor, 1000 Tenth Avenue, , New York, New York 10019 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53145 Certified Capacity: 15 with Telepractice Designation [up to 15 beds may be used for the provision of medically managed withdrawal & stabilization services (816.6) as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12111_MountS.pdf
September 21, 2021 Page 127 of 225 Certificate Number: 210712112 Amendment Effective: 09/01/2020 Anticipated Recert Review: 7/31/2021 Program Location: 429 West 58th Street, New York, New York 10019 Service Type: Opioid Treatment Program (822) PRU: 53149 Certified Capacity: 350 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12112_MountS.pdf
Certificate Number: 220812275 Establishment Effective: 09/13/2021 Anticipated Recert Review: 8/31/2022 Program Location: 1111 Amsterdam Avenue, , New York, New York 10025 Service Type: Other Licensed Practitioners PRU: 53576 Certified Capacity:
Program Name:
Service Type: Psychosocial Rehabilitation (PSR) PRU: 53577 Certified Capacity:
Program Name: CARES (Comprehensive Adolescent Rehabilitation and Education Services)
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12275_MountS.pdf
Mountain View Prevention Services, Inc. Provider Number: 36320 Mr. Christopher Paige, Executive Director Telephone - (315)-376-2321 Administrative Office: 7714 Number Three Road, Lowville, NY 13367
Certificate Number: 230212035 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/28/2023 Program Location: Administrative Site Only:, First Floor East, 7714 Number Three Road, Lowville, New York 13367 Service Type: Prevention Counseling PRU: 90693 Certified Capacity:
Program Name:
Adirondack Central School, 8181 State Route 294, Boonville, NY 13309 Other Service Site(s) At: South Lewis Central School, 2nd Floor, Room 209, 4264 East Road, Turin, NY 13473 Other Service Site(s) At: Beaver River Central School, Office, 1st Floor, Adjacent to Room 152, 9508 Artz Road, Beaver Falls, NY 13305 Other Service Site(s) At: Lowville Academy & Central School, 3rd Floor, Room Adjacent to Science Lab, 7668 North State Street, Lowville, NY 13367 Other Service Site(s) At: Harrisville Central School, Room A115, 14357 Pirate Lane, Harrisville, NY 13648 Other Service Site(s) At: Copenhagen Central School, 1st Floor, Room 73A, 3020 Mechanic Street, Copenhagen, NY 13620 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12035_Mounta.pdf
Mountainside NYC LLC Provider Number: 50170 Ms. Alexandra Helfer LMHC, Executive Director Telephone - (860)-824-1397 Ext 165 Administrative Office: Suite 1601, 2nd Floor, 347 West 36th Street, New York, NY 10018
September 21, 2021 Page 128 of 225 d/b/a Mountainside Chappaqua Certificate Number: 210512149 Amendment Effective: 05/28/2020 Anticipated Recert Review: 5/31/2021 Program Location: 2nd Floor, 480 Bedford Road, Chappaqua, New York 10514 Service Type: Outpatient Service (822) PRU: 53240 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12149_Mounta.pdf d/b/a Mountainside Huntington Certificate Number: 231212195 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2023 Program Location: 2nd Floor, 141 East Main Street, , Huntington, New York 11743 Service Type: Outpatient Service (822) PRU: 53352 Certified Capacity: with Telepractice Designation
Program Name: Mountainside Huntington Outpatient
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12195_Mounta.pdf
Nassau Alternative Advocacy Program, Inc. Provider Number: 41400 Mr. Timothy Andrews, Executive Director Telephone - (516)-741-3111 Administrative Office: Suite 102, 151 Herricks Road, Garden City Park, NY 11040
Certificate Number: 201211269 Amendment Effective: 05/29/2020 Anticipated Recert Review: 12/31/2020 Program Location: Suite 102, 151 Herricks Road, Garden City Park, New York 11040 Service Type: Outpatient Service (822) PRU: 51819 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11269_Nassau.pdf
Nassau County Office of Mental Health, Chemical Dependency and Developmental Disabilities Services Provider Number: 40150 Ms. Omayra Perez, Director Telephone - Administrative Office: Suite 200, 60 Charles Lindbergh Boulevard, Uniondale, NY 11553
Certificate Number: 210210368 Amendment Effective: 07/10/2020 Anticipated Recert Review: 2/28/2021 Program Location: Nassau County Medical Center, Building K, 2nd Floors, Basement, 1st &, 2201 Hempstead Turnpike, East Meadow, New York 11554 Service Type: Opioid Treatment Program (822) PRU: 52127 Certified Capacity: 650 with Telepractice Designation
Program Name: Service Type: Opioid Medical Maintenance (822) PRU: 52128 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10368_Nassau.pdf
September 21, 2021 Page 129 of 225 Nassau Health Care Corporation d/b/a Nassau University Medical Hospital Provider Number: 85020 Mr. Anthony Boutin, Chief Executive Officer Telephone - 516-572-8730 Administrative Office: Building G, 2201 Hempstead Turnpike, East Meadow, NY 11554
Certificate Number: 210610273 Renewal Deemed Effective: 07/12/2018 Anticipated Recert Review: 6/9/2021 Program Location: 10th Floor, 2201 Hempstead Turnpike, East Meadow, New York 11554 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 50296 Certified Capacity: 20 [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10273_Nassau.pdf
Certificate Number: 210611615 Renewal Deemed Effective: 07/12/2018 Anticipated Recert Review: 6/9/2021 Program Location: 10th Floor, 2201 Hempstead Turnpike, East Meadow, New York 11554 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 52094 Certified Capacity: 30
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11615_Nassau.pdf
National Society for Hebrew Day Schools Provider Number: 796 Mr. Martin Wangrofsky, Executive Director Telephone - (718)-787-4412 Administrative Office: Suite 203, 813 Quentin Road, Brooklyn, NY 11223
Certificate Number: 210211977 Amendment Effective: 12/07/2020 Anticipated Recert Review: 2/28/2021 Program Location: Suite 203, 813 Quentin Road, Brooklyn, New York 11223 Service Type: Prevention Counseling PRU: 90739 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Prevention Counseling PRU: 90740 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Prevention Counseling PRU: 90741 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Prevention Counseling PRU: 90742 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Prevention Counseling PRU: 90743 Certified Capacity: with Telepractice Designation
Program Name:
Hebrew Academy of Nassau County, 2nd Floor, Conference Room, 609 Hempstead Avenue, West Hempstead, NY 11552 Other Service Site(s) At: Hebrew Academy of Nassau County, 1st Floor, Guidance Office, 25 Country Drive, Plainview, NY 11803 Other Service Site(s) At:
September 21, 2021 Page 130 of 225 Torah Academy for Girls, Room 308, 444 Beach 6th Street, Far Rockaway, NY 11691 Other Service Site(s) At: Yeshiva and Mesivta Torah Vodaath, 4th Floor, Guidance Office, 425 East 9th Street, Brooklyn, NY 11218 Other Service Site(s) At: The Pathways Study Center, Ground Floor, 1305 Coney Island Avenue, Brooklyn, NY 11230 Other Service Site(s) At: Beth Jacob Parochial School of the East Side, 142 Broome Street, New York, NY 10002 Other Service Site(s) At: Yeshiva & Mesivta Torah Temimah, Room 401, 555 Ocean Parkway, Brooklyn, NY 11218 Other Service Site(s) At: Beth Jacob of Boro Park, Basement, 1372 46th Street, Brooklyn, NY 11219 Other Service Site(s) At: Bnos Yaakov of Pupa, 1st Floor, Guidance Office, 1402 40th Street, Brooklyn, NY 11218 Other Service Site(s) At: Yeshiva Darchei Torah, 257 Beach 17th Street, Far Rockaway, NY 11691 Other Service Site(s) At: Rabbi Samson Raphael Hirsch School, 1st Floor, 85-93 Bennett Avenue, Brooklyn, NY 10033 Other Service Site(s) At: Jewish Foundation School, 1st Floor, Counseling Room, 400 Caswell Ave., Staten Island, NY 10314 Other Service Site(s) At: Ahi Ezer Yeshiva, 2344 Ocean Parkway, Brooklyn, NY 11235 Other Service Site(s) At: United Lubavitcher Yeshiva, 2nd Floor, Guidance Office, 841 Ocean Parkway, Brooklyn, NY 11230 Other Service Site(s) At: Bais Chaya Mushka, 1505 Carroll Street, Brooklyn, NY 11213 Other Service Site(s) At: Rabbi Jacob Joseph School, 2nd Floor, Room #205, 3495 Richmond Road, Staten Island, NY 10306 Other Service Site(s) At: Beth Rivka Elementary School, 1st Floor, Conference Room, 470 Lefferts Avenue, Brooklyn, NY 11225 Other Service Site(s) At: Shulamith School for Girls, 2nd Floor, Guidance Office, 1277 East 14th Street, Brooklyn, NY 11230 Other Service Site(s) At: Yeshiva Toras Emes Kamenitz, 4th Floor, Library, 1904 Avenue N, Brooklyn, NY 11230 Other Service Site(s) At: Yeshiva Sha'arei Zion, 75-24 Grand Central Parkway, Forest Hills, NY 11375 Other Service Site(s) At: Yeshiva Ketana of Queens, 78-15 Parsons Boulevard, Flushing, NY 11366 Other Service Site(s) At: Mesivtha Tifereth Jerusalem, 1st Floor, Guidance Room, 145 East Broadway, New York, NY 10002 Other Service Site(s) At: Bet Yaakov Orot Sarah, Room 303, 1125 Avenue N, Brooklyn, NY 11230 Other Service Site(s) At: Hebrew Academy of Five Towns and Rockaway, 1st Floor, Guidance Office, 33 Washington Avenue, Lawrence, NY 11559 Other Service Site(s) At: Bnow Yisroel School for Girls, 1629 E. 15th Street, Brooklyn, NY 11229 Other Service Site(s) At:
September 21, 2021 Page 131 of 225 Yeshiva Ktana of Manhattan, 1st Floor, Guidance Office, 348 West 89th Street, New York, NY 10024 Other Service Site(s) At: Tomer Devora School for Girls, Tutoring Room B, 4500 9th Avenue, Brooklyn, NY 11220 Other Service Site(s) At: Mirrer Yeshiva High School, 1st Floor, Guidance Office, 1795 Ocean Parkway, Brooklyn, NY 11223 Other Service Site(s) At: Ezra Academy, 5th Floor, Conference Room, 119-45 Union Turnpike, Forest Hills, NY 11375 Other Service Site(s) At: Bais Yaakov D'Chassidei Gur, 1st Floor, Social Worker's Office, 1975 51st Street, Brooklyn, NY 11204 Other Service Site(s) At: Yeshiva Chasen Sofer Elementary School, 1st Floor, Guidance Office, 1876 50th Street, Brooklyn, NY 11204 Other Service Site(s) At: Prospect Park Elementary School, 1st Floor, Guidance Office, 1784 East 17th Street, Brooklyn, NY 11229 Other Service Site(s) At: Mesivta Chasan Sofer High School, 1st Floor, Guidance Office, 5001 19th Avenue, Brooklyn, NY 11204 Other Service Site(s) At: Masores Bais Yaakov, 1st Floor, Guidance Office, 1395 Ocean Avenue, Brooklyn, NY 11230 Other Service Site(s) At: Yeshiva of Brooklyn, 1st Floor, Guidance Office, 1470 Ocean Parkway, Brooklyn, NY 11230 Other Service Site(s) At: Yeshiva Ahavas Torah, 2961 Nostrand Avenue, Brooklyn, NY 11229 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11977_Nation.pdf
Neighborhood Coalition for Shelter, Inc. Provider Number: 19920 Ms. Ann Shalof, Executive Director Telephone - (212)-537-5120 Administrative Office: Suite 1301, 50 Broadway, New York, NY 10004
Certificate Number: 220811623 Amendment Effective: 08/31/2020 Anticipated Recert Review: 8/31/2022 Program Location: Basement, 921-923 Madison Avenue, New York, New York 10021 Service Type: Outpatient Service (822) PRU: 52103 Certified Capacity: with Telepractice Designation
Program Name: Chance for Change Service Type: Outpatient Service (822) PRU: 52103 Certified Capacity: with Telepractice Designation
Program Name: Chance for Change
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11623_Neighb.pdf
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11623_Neighb.pdf
Never Alone, Inc. Provider Number: 19010 Mr. Patricia Mauer, President and Chief Executive Telephone - (845)-339-4272 Ext 12 Administrative Office: Officer 20 Crofts Road, Hurley, NY 12443
September 21, 2021 Page 132 of 225 Certificate Number: 220211630 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/28/2022 Program Location: 20 Crofts Road, Hurley, New York 12443 Service Type: Residential Rehabilitation Services for Youth (817) PRU: 51240 Certified Capacity: 22
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11630_NeverA.pdf
New Hope Manor, Inc. Provider Number: 219 Ms. Sarah Eilbacher, Executive Director Telephone - (845)-557-8353 Administrative Office: 35 Hillside Road, Barryville, NY 12719
Certificate Number: 231212047 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2023 Program Location: 35 Hillside Road, Barryville, New York 12719 Service Type: Residential Services (820) PRU: 53065 Certified Capacity: 53 and up to 12 beds for children Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12047_NewHop.pdf
Certificate Number: 220112068 Conditional Certificate Effective: 02/01/2021 Anticipated Recert Review: 1/31/2022 Program Location: 1st & 2nd Floors, 141 South Avenue, Poughkeepsie, New York 12601 Service Type: Residential Services (820) PRU: 53064 Certified Capacity: 10 and up to 3 beds for children Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12068_NewHop.pdf
The New Horizon Counseling Center, Inc. Provider Number: 15440 Mr. Herrick Lipton, Chief Executive Officer Telephone - (718)-845-2670 Administrative Office: 108-19 Rockaway Boulevard, South Ozone, NY 11420
Certificate Number: 240411865 Renewal OMH Host Effective: 05/01/2021 Anticipated Recert Review: 4/30/2024 Program Location: 50 West Hawthorne Avenue, Valley Stream, New York 11580 Service Type: Outpatient Service (822) PRU: 52804 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11865_NewHor.pdf
The New York and Presbyterian Hospital Provider Number: 81170 Steven J. Corwin M.D., Chief Executive Officer Telephone - (212)-305-8000 Administrative Office: 525 East 68th Street, New York, NY 10021
September 21, 2021 Page 133 of 225 Certificate Number: 230710400 Amendment Deemed Effective: 07/08/2020 Anticipated Recert Review: 7/7/2023 Program Location: The Helmsley Medical Tower, 1st Floor, 503 East 70th Street, New York, New York 10021 Service Type: Opioid Treatment Program (822) PRU: 331 Certified Capacity: 200 with Telepractice Designation
Program Name: Service Type: Opioid Medical Maintenance (822) PRU: 52205 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10400_NewYor.pdf
Certificate Number: 200511414 Special ReIssue Deemed Effective: 01/01/2018 Anticipated Recert Review: 5/20/2020 Program Location: 8 North Unit, 7-8-8A, 2nd Floor, 21 Bloomingdale Road, White Plains, New York 10605 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50289 Certified Capacity: 14
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11414_NewYor.pdf
New York Center For Living, Inc. Provider Number: 45160 Audrey Freshman Ph.D., Executive Director Telephone - 212-712-8800 Administrative Office: 226 East 52nd Street, New York, NY 10022
Certificate Number: 220712029 Amendment Effective: 05/29/2020 Anticipated Recert Review: 7/31/2022 Program Location: 224-226 East 52nd Street, New York, New York 10022 Service Type: Outpatient Service (822) PRU: 53007 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12029_NewYor.pdf
New York City Department of Police Provider Number: 28880 Tremaine Sayles, Executive Director Telephone - 718-760-7557 Administrative Office: Medical Division NYPD, 15th Floor, 59-17 Junction Blvd, Corona, NY 11368
Certificate Number: 190411596 Conditional Certificate Effective: 05/01/2018 Anticipated Recert Review: 4/30/2019 Program Location: 25 Elm Place, , Brooklyn, New York 11201 Service Type: Outpatient Service (822) PRU: 52068 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11596_NewYor.pdf
New York City Health and Hospitals Corporation Bellevue Hospital Center Provider Number: 85120 Mr. William Hicks, Chief Executive Officer Telephone - (212)-562-4132 Administrative Office: H Building, NB-ME8, 462 First Avenue, New York, NY 10016
September 21, 2021 Page 134 of 225 Certificate Number: 230210442 Renewal Deemed Effective: 05/01/2021 Anticipated Recert Review: 2/26/2023 Program Location: 4th Floor, 462 First Avenue, New York, New York 10016 Service Type: Opioid Treatment Program (822) PRU: 422 Certified Capacity: 400 [with ancillary withdrawal services for up to 40 patients] with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10442_NewYor.pdf
Certificate Number: 231210618 Amendment Deemed Effective: 03/10/2021 Anticipated Recert Review: 12/31/2023 Program Location: C & D Building, 2nd Floor, 462 First Avenue, New York, New York 10016 Service Type: Outpatient Service (822) PRU: 51912 Certified Capacity: [with ancillary withdrawal services] with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10618_NewYor.pdf
New York City Health and Hospitals Corporation Coney Island Hospital Provider Number: 87050 Ms. Svetlana Lipyanskaya, Chief Executive Officer Telephone - (718)-616-6020 Administrative Office: Room 2W6, 2601 Ocean Parkway, Brooklyn, NY 11235
Certificate Number: 240410558 Renewal Effective: 05/01/2021 Anticipated Recert Review: 4/30/2024 Program Location: 2925 West 19th Street, Brooklyn, New York 11224 Service Type: Outpatient Service (822) PRU: 50320 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10558_NewYor.pdf
New York City Health and Hospitals Corporation Cumberland Diagnostic & Treatment Center Provider Number: 85450 Michelle Lewis, Chief Executive Officer Telephone - 718-260-7895 Administrative Office: 100 North Portland Avenue, Brooklyn, NY 11205
Certificate Number: 220610578 Conditional Certificate Effective: 07/01/2021 Anticipated Recert Review: 6/30/2022 Program Location: 1st & 2nd Floors, Basement,, 100 North Portland Avenue, Brooklyn, New York 11205 Service Type: Outpatient Service (822) PRU: 51910 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Alcoholism Treatment Program Service Type: Outpatient Rehabilitation Service (822) PRU: 53165 Certified Capacity: with Telepractice Designation
Program Name: Alcoholism Treatment Program
Administration for Children's Services, 185 Marcy Avenue, Brooklyn, NY 11211 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10578_NewYor.pdf
September 21, 2021 Page 135 of 225 New York City Health and Hospitals Corporation Elmhurst Hospital Center Provider Number: 87040 Mr. Israel Rocha, Chief Executive Officer Telephone - (718)-334-1638 Administrative Office: Annex O, 8th Floor, 79-01 Broadway, Elmhurst, NY 11373
Certificate Number: 220910464 Amendment Deemed Effective: 04/14/2021 Anticipated Recert Review: 9/28/2022 Program Location: Annex O, 2nd Floor, 79-01 Broadway, , Elmhurst, New York 11373 Service Type: Opioid Treatment Program (822) PRU: 320 Certified Capacity: 300 with Telepractice Designation [with ancillary withdrawal services for up to 30 patients]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10464_NewYor.pdf
Certificate Number: 220910900 Amendment Deemed Effective: 04/14/2021 Anticipated Recert Review: 9/28/2022 Program Location: Building H, 3rd Floor, 79-01 Broadway, Elmhurst, New York 11373 Service Type: Outpatient Service (822) PRU: 50223 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Elmhurst Hospital
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10900_NewYor.pdf
New York City Health and Hospitals Corporation Harlem Hospital Center Provider Number: 85130 Ms. Eboné Carrington, Chief Executive Officer Telephone - (212)-939-1340 Administrative Office: Room MLK 2143, 506 Lenox Avenue, New York, NY 10037
Certificate Number: 230510610 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2023 Program Location: Mural Pavilion, 5th Floor, 506 Lenox Avenue, , New York, New York 10037 Service Type: Outpatient Service (822) PRU: 50316 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10610_NewYor.pdf
New York City Health and Hospitals Corporation Jacobi Medical Center Provider Number: 85140 Mr. Christopher Mastromano, CEO Telephone - (718)-918-8141 Administrative Office: Building 1, Room 159, 1400 Pelham Parkway South, Bronx, NY 10461
Certificate Number: 220610609 Conditional Certificate Effective: 07/01/2021 Anticipated Recert Review: 6/30/2022 Program Location: Jacobi Medical Center, Floor #s 9W & 9N, Building #1, 1400 Pelham Parkway South, Bronx, New York 10461 Service Type: Outpatient Service (822) PRU: 51889 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10609_NewYor.pdf
New York City Health and Hospitals Corporation Kings County Hospital Center Provider Number: 87030 Mr. Sheldon McLeod, Chief Executive Officer Telephone - (718)-245-3901 Administrative Office: B Building, Suite B1137, 451 Clarkson Avenue, Brooklyn, NY 11203
September 21, 2021 Page 136 of 225 Certificate Number: 240310462 Renewal Deemed Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: Support Office Building (SOB), 591 Kingston Avenue, , Brooklyn, New York 11203 Service Type: Opioid Treatment Program (822) PRU: 920 Certified Capacity: 750 with Telepractice Designation [with ancillary withdrawal services for up to 75 patients]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10462_NewYor.pdf
Certificate Number: 220910574 Amendment Effective: 08/31/2020 Anticipated Recert Review: 9/30/2022 Program Location: R Building, 2 South Wing, 2nd Floor, 410 Winthrop Street, Brooklyn, New York 11203 Service Type: Outpatient Service (822) PRU: 51909 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 53163 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10574_NewYor.pdf
New York City Health and Hospitals Corporation Lincoln Medical and Mental Health Center Provider Number: 84150 Mr. Milton Nunez, Executive Director Telephone - (718)-579-5700 Administrative Office: 234 East 149th Street, Bronx, NY 10451
Certificate Number: 220710894 Amendment Effective: 07/31/2020 Anticipated Recert Review: 7/31/2022 Program Location: 545 East 142nd Street, Bronx, New York 10454 Service Type: Outpatient Service (822) PRU: 6813 Certified Capacity: with Telepractice Designation
Program Name: Recovery Center at Belvis Diagnostic & Treatment Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10894_NewYor.pdf
New York City Health and Hospitals Corporation Metropolitan Hospital Center Provider Number: 81210 Ms. Alina Moran, Executive Director Telephone - (212)-423-7727 Administrative Office: Suite 1B2, 1901 First Avenue, New York, NY 10029
Certificate Number: 221010402 Amendment Effective: 08/03/2020 Anticipated Recert Review: 10/31/2022 Program Location: Psychiatric Pavillion, Room 2M29, 2nd Floor, 1900 2nd Avenue, , New York, New York 10029 Service Type: Opioid Treatment Program (822) PRU: 669 Certified Capacity: 300 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10402_NewYor.pdf
September 21, 2021 Page 137 of 225 New York City Health and Hospitals Corporation Queens Hospital Center Provider Number: 87060 Mr. Israel Rocha, CEO Telephone - (718)-883-2351 Administrative Office: Pavilion Building, Room 345, 82-50 164th Street, Jamaica, NY 11432
Certificate Number: 210510621 Amendment Deemed Effective: 08/21/2020 Anticipated Recert Review: 5/31/2021 Program Location: Pavilion Building, Room 345, 3rd Floor, 82-50 164th Street, , Jamaica, New York 11432 Service Type: Outpatient Service (822) PRU: 51908 Certified Capacity: with Telepractice Designation
Program Name: Comprehensive Chemical Dependency Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10621_NewYor.pdf
New York City Health and Hospitals Corporation Woodhull Medical and Mental Health Center Provider Number: 85180 Mr Gregory J. Calliste, Chief Executive Officer Telephone - (718)-519-3500 Administrative Office: Administrative Office, 760 Broadway, Brooklyn, NY 11206
Certificate Number: 230310898 Amendment Deemed Effective: 09/17/2020 Anticipated Recert Review: 3/7/2023 Program Location: 5th& 9th Floors, 760 Broadway, Brooklyn, New York 11206 Service Type: Outpatient Service (822) PRU: 50911 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10898_NewYor.pdf
New York State Office of Addiction Services and Supports Bronx Addiction Treatment Center Provider Number: 90008 Ms Tabatha Cotto, Telephone - Administrative Office: Building #13, Room 205, 2nd Floor, 1500 Waters Place, Bronx, NY 10461
Certificate Number: 220311378 Special ReIssue Effective: 10/29/2019 Anticipated Recert Review: 3/31/2022 Program Location: Building 13, 1500 Waters Place, , Bronx, New York 10461 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50740 Certified Capacity: 38 with Telepractice Designation [with the use of methadone]
Program Name: Bronx ATC IP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11378_NewYor.pdf
New York State Office of Addiction Services and Supports Charles K. Post Addiction Treatment Center Provider Number: 90013 Ms. Elaine DuBissette, Director Telephone - (631)-434-7209 Administrative Office: Pilgrim Psychiatric Center Campus - Building 1, 998 Crooked Hill Road, West Brentwood, NY 11717
Certificate Number: 210511379 Special ReIssue Effective: 10/29/2019 Anticipated Recert Review: 5/31/2021 Program Location: Pilgrim Psychiatric Center, Building 1, North Wing, 1st and 2nd Floors, 998 Crooked Hill Road, West Brentwood, New York 11717 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50749 Certified Capacity: 51 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11379_NewYor.pdf
September 21, 2021 Page 138 of 225 Certificate Number: 181211432 Special ReIssue Effective: 07/24/2018 Anticipated Recert Review: 12/31/2018 Program Location: Pilgrim Psychiatric Center, First Floor, North Wing, Building 1, 998 Crooked Hill Road, West Brentwood, New York 11717 Service Type: Community Residential (819) PRU: 50753 Certified Capacity: 42 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11432_NewYor.pdf
New York State Office of Addiction Services and Supports Creedmoor Addiction Treatment Center Provider Number: 90009 Ms. Margaret Hurst, Director Telephone - (718)-264-3755 Administrative Office: Building 19, CBU 15, 80-45 Winchester Boulevard, Queens Village, NY 11427
Certificate Number: 240312127 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: Building 19, CBU 15, 80-45 Winchester Boulevard, Queens Village, New York 11427 Service Type: Residential Services (820) PRU: 53203 Certified Capacity: 26 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12127_NewYor.pdf
New York State Office of Addiction Services and Supports Dick Van Dyke Addiction Treatment Center Provider Number: 90003 Mr. Andrew Merrill, Director Telephone - (315)-835-6153 Administrative Office: Room 229, 1330 County Road 132, Ovid, NY 14521
Certificate Number: 211011381 Special ReIssue Effective: 10/29/2019 Anticipated Recert Review: 10/31/2021 Program Location: [Mailing Address at], Ovid, New York 14521, 1330 County Road 132, 7116 County Road 132, Bldg. 112, [Services Provided at], Willard, New York 14588 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50725 Certified Capacity: 30 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11381_NewYor.pdf
New York State Office of Addiction Services and Supports John L. Norris Addiction Treatment Center Provider Number: 90002 Mr. Jason Goldwasser, Director Telephone - (716)-461-0410 Ext 240 Administrative Office: Building 1, Room 146, 1stFloor, 1111 Elmwood Avenue, Rochester, NY 14620
Certificate Number: 240211382 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/29/2024 Program Location: Rochester Psychiatric Center, Building 1, 1st Floor, 1732 South Avenue, Rochester, New York 14620 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50722 Certified Capacity: 44 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11382_NewYor.pdf
September 21, 2021 Page 139 of 225 New York State Office of Addiction Services and Supports Kingsboro Addiction Treatment Center Provider Number: 90014 Ms. Vibeke Velez, Director Telephone - (718)-453-3200 Administrative Office: Main Building, Room 206, 2nd Floor, 754 Lexington Avenue, Brooklyn, NY 11221
Certificate Number: 210311383 Special ReIssue Effective: 10/29/2019 Anticipated Recert Review: 3/31/2021 Program Location: 754 Lexington Avenue, , Brooklyn, New York 11221 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 51996 Certified Capacity: 10 with Telepractice Designation [located in the East Wing, 5th Floor]**Any portion of these beds may be used for the provision of inpatient rehabilitation services, as needed. [With the use of Methadone]
Program Name: Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53442 Certified Capacity: 60 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11383_NewYor.pdf
New York State Office of Addiction Services and Supports Margaret A. Stutzman Addiction Treatment Center Provider Number: 90001 Mr. Robert Chapman, Executive Director Telephone - (716)-882-4900 Ext 225 Administrative Office: 360 Forest Avenue, Buffalo, NY 14213
Certificate Number: 210411385 Special ReIssue Effective: 10/29/2019 Anticipated Recert Review: 4/30/2021 Program Location: Building 37, 360 Forest Avenue, Buffalo, New York 14213 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50719 Certified Capacity: 33 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11385_NewYor.pdf
New York State Office of Addiction Services and Supports McPike Addiction Treatment Center Provider Number: 90004 Mr. Stephen McLaughlin, Director Telephone - (315)-738-4600 Administrative Office: Room B203, 2nd Floor, 1213 Court Street, Utica, NY 13502
Certificate Number: 220211386 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/28/2022 Program Location: 1213 Court Street, Utica, New York 13502 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50727 Certified Capacity: 68 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11386_NewYor.pdf
New York State Office of Addiction Services and Supports Richard C. Ward Addiction Treatment Center Provider Number: 90006 Ms. Christina Murphy, Assistant Director Telephone - (845)-905-2206 Administrative Office: Administration Wing, Building 92 - Suite 12-16, 1st Floor, 117 Seward Avenue, Middletown, NY 10940
September 21, 2021 Page 140 of 225 Certificate Number: 210312157 Amendment Effective: 12/11/2020 Anticipated Recert Review: 3/31/2021 Program Location: Building 92, Suites 12-16, 117 Seward Avenue, , Middletown, New York 10940 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53495 Certified Capacity: 48 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12157_NewYor.pdf
New York State Office of Addiction Services and Supports Russell E. Blaisdell Addiction Treatment Center Provider Number: 90007 Ms. Emily Feiner, Director Telephone - (845)-359-8500 Administrative Office: Nathan Kline Institute, Building 35, 140 Old Orangeburg Road, Orangeburg, NY 10962
Certificate Number: 210211387 Special ReIssue Effective: 10/29/2019 Anticipated Recert Review: 2/28/2021 Program Location: Rockland Psychiatric Center, Building 57, 5th and 6th Floors, 140 Old Orangeburg Road, , Orangeburg, New York 10962 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50735 Certified Capacity: 52 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11387_NewYor.pdf
New York State Office of Addiction Services and Supports South Beach Addiction Treatment Center Provider Number: 90012 Ms. Nadia Huntley-Smith, Director Telephone - (718)-667-5202 Administrative Office: South Beach Psychiatric Center, Building 3, Room 807, 2nd Floor, 777 Seaview Avenue, Staten Island, NY 10305
Certificate Number: 210211388 Special ReIssue Effective: 10/29/2019 Anticipated Recert Review: 2/28/2021 Program Location: South Beach Psychiatric Center, Building 3, 777 Seaview Avenue, Staten Island, New York 10305 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50748 Certified Capacity: 30 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11388_NewYor.pdf
New York State Office of Addiction Services and Supports St. Lawrence Addiction Treatment Center Provider Number: 90005 Mr. William Coppola, Director Telephone - (315)-393-1180 Administrative Office: Hamilton Hall, 1 Chimney Point Drive, Ogdensburg, NY 13669
Certificate Number: 240311389 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: 1 Chimney Point Drive, Ogdensburg, New York 13669 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50730 Certified Capacity: 40 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11389_NewYor.pdf
September 21, 2021 Page 141 of 225 New York State Office of Children and Family Services Provider Number: 28720 Ms. Sheila J. Poole, Acting Commissioner Telephone - (845)-615-3011 Administrative Office: Office of Program Services/Division of Rehabilitation Services, Capital View Office Park, 6th Floor, 52 Washington Street, Rensselaer, NY 12144
Certificate Number: 180611788 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 6/30/2018 Program Location: Brookwood Secure Center, 419 Spookrock Road, P.O. Box 265, Claverack, New York 12513 Service Type: Chemical Dependency Specialized Services (824) PRU: 52649 Certified Capacity: 30
Program Name: Discrete Addiction Service Unit
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11788_NewYor.pdf
Certificate Number: 180611791 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 6/30/2018 Program Location: Highland Residential Center, Unit #41, 629 North Chodikee Lake Road, PO Box 970, Highland, New York 12528 Service Type: Chemical Dependency Specialized Services (824) PRU: 52651 Certified Capacity: 17
Program Name: Discrete Addiction Service Unit
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11791_NewYor.pdf
New York Therapeutic Communities, Inc. Provider Number: 587 Mr Sandeep Varma, Chief Executive Telephone - (212)-971-6033 Administrative Office: Officer/President 21st Floor, 266 West 37th Street, New York, NY 10018
Certificate Number: 181210210 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 2071 Fulton Street, Brooklyn, New York 11233 Service Type: Intensive Residential Rehabilitation (819) PRU: 5682 Certified Capacity: 57
Program Name: Serendipity I - The John David Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10210_NewYor.pdf
Certificate Number: 181211306 Special ReIssue Effective: 01/17/2018 Anticipated Recert Review: 12/31/2018 Program Location: Floors 1-4, 944 Bedford Avenue, , Brooklyn, New York 11205 Service Type: Intensive Residential Rehabilitation (819) PRU: 7191 Certified Capacity: 40 for women
Program Name: Serendipity II - The Madeline Randers Center Service Type: Intensive Residential Rehabilitation (819) PRU: 7191 Certified Capacity: 40 for women
Program Name: Serendipity II - The Madeline Randers Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11306_NewYor.pdf
September 21, 2021 Page 142 of 225 Certificate Number: 210911486 Amendment Effective: 04/25/2019 Anticipated Recert Review: 9/30/2021 Program Location: 2071 Fulton Street, Brooklyn, New York 11233 Service Type: Outpatient Service (822) PRU: 51994 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11486_NewYor.pdf
Certificate Number: 221111583 Amendment Effective: 10/02/2020 Anticipated Recert Review: 11/30/2022 Program Location: Lower Level, 162-24 Jamaica Avenue, Jamaica, New York 11432 Service Type: Outpatient Service (822) PRU: 52057 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11583_NewYor.pdf
Niagara County Department of Mental Health Services Provider Number: 70150 Ms. Laura Kelemen, Director Telephone - (716)-439-7410 Administrative Office: Suite #200, 5467 Upper Mountain Road, Lockport, NY 14094
Certificate Number: 220512026 Amendment OMH Host Effective: 09/04/2020 Anticipated Recert Review: 5/31/2022 Program Location: Trott Access Center, 2nd Floor, 1001 11th Street, Niagara Falls, New York 14301 Service Type: Outpatient Service (822) PRU: 52984 Certified Capacity: with Telepractice Designation
Program Name:
Shaw Building, 5467 Upper Mountain Road, Lockport, NY 14094 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12026_Niagar.pdf
North Country Freedom Homes, Inc. Provider Number: 36160 Ms. Jennifer Barron, Director of Services Telephone - (315)-379-0139 Ext 4 Administrative Office: 25 Dies Street, Canton, NY 13617
Certificate Number: 181210151 Conditional Certificate Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 25 Dies Street, Canton, New York 13617 Service Type: Community Residential (819) PRU: 50499 Certified Capacity: 24 with Telepractice Designation
Program Name: Canton House Community Residential Service
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10151_NorthC.pdf
North Crown Heights Family Outreach Center, Inc. Provider Number: 42930 Ms. Susana Dobrer, Executive Director Telephone - (718)-230-8600 Administrative Office: 765 Nostrand Avenue #763, Brooklyn, NY 11216
September 21, 2021 Page 143 of 225 Certificate Number: 200811459 Renewal Effective: 09/01/2018 Anticipated Recert Review: 8/31/2020 Program Location: 763-765 Nostrand Avenue, Brooklyn, New York 11216 Service Type: Outpatient Service (822) PRU: 51973 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11459_NorthC.pdf
North Shore Child and Family Guidance Association, Inc. Provider Number: 21730 Mr. Andrew Malekoff, Executive Director/CEO Telephone - (516)-626-1971 Ext 302 Administrative Office: 480 Old Westbury Road, Roslyn Heights, NY 11577
Certificate Number: 211211497 Amendment Effective: 06/22/2020 Anticipated Recert Review: 12/31/2021 Program Location: 999 Brush Hollow Road, Westbury, New York 11590 Service Type: Outpatient Service (822) PRU: 51657 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11497_NorthS.pdf
Northpointe Council, Inc. Provider Number: 38020 Ms. Kristi Yerger, President & CEO Telephone - (716)-282-1228 Administrative Office: Suite 2A, 800 Main Street, Niagara Falls, NY 14301
Certificate Number: 190710509 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 7/31/2019 Program Location: 2470 Allen Avenue, Niagara Falls, New York 14303 Service Type: Medically Monitored Withdrawal & Stabilization Services (816.9) PRU: 8028 Certified Capacity: 17
Program Name: First Step Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10509_Northp.pdf
Certificate Number: 220910656 Amendment Effective: 04/09/2020 Anticipated Recert Review: 9/30/2022 Program Location: Lockview Plaza, Suite 201, Second Floor, 41 Main Street, Lockport, New York 14094 Service Type: Outpatient Service (822) PRU: 50083 Certified Capacity: with Telepractice Designation
Program Name:
6395 Old Niagara Road, Lockport, NY 14094 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10656_Northp.pdf
Certificate Number: 210411250 Amendment Effective: 04/09/2020 Anticipated Recert Review: 4/30/2021 Program Location: 1001 11th Street, Niagara Falls, New York 14301 Service Type: Outpatient Service (822) PRU: 51852 Certified Capacity: with Telepractice Designation
Program Name:
September 21, 2021 Page 144 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11250_Northp.pdf
Certificate Number: 221011696 Amendment Effective: 04/09/2020 Anticipated Recert Review: 10/31/2022 Program Location: 1001 11th Street, , Niagara Falls, New York 14301 Service Type: Opioid Full Agonist Treatment Program (822) PRU: 52232 Certified Capacity: 85 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11696_Northp.pdf
Certificate Number: 210712075 Renewal Effective: 08/01/2018 Anticipated Recert Review: 7/31/2021 Program Location: 2470 Allen Avenue, Niagara Falls, New York 14303 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 52971 Certified Capacity: 7 - [up to 7 beds may be used for the provision of medically monitored withdrawal & stabilization services]
Program Name: First Step Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12075_Northp.pdf
Northwell Healthcare, Inc. as Sponsor Phelps Memorial Hospital Association as Operator Provider Number: 85310 Ms. Eileen Egan, Executive Director Telephone - Administrative Office: Administration - 1st Floor, 701 North Broadway, Sleepy Hollow, NY 10591
Certificate Number: 220910597 Amendment Effective: 04/22/2020 Anticipated Recert Review: 9/30/2022 Program Location: 22 Rockledge Avenue, Ossining, New York 10562 Service Type: Outpatient Service (822) PRU: 51620 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51941 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10597_Northw.pdf
Certificate Number: 220911392 Amendment Deemed Effective: 10/02/2020 Anticipated Recert Review: 9/28/2022 Program Location: 2nd Floor (South Wing), 701 North Broadway, , Sleepy Hollow, New York 10591 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51617 Certified Capacity: 22 with Telepractice Designation
Program Name: Behavioral Rehabilitation Unit
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11392_Northw.pdf
Northwell Healthcare, Inc. as Sponsor The Long Island Home d/b/a South Oaks Hospital as Operator Provider Number: 81980 Dr Carolyn Sweetapple Ph.D., Executive Director Telephone - (631)-608-5105 Administrative Office: 400 Sunrise Highway, Amityville, NY 11701
September 21, 2021 Page 145 of 225 Certificate Number: 210110634 Amendment Effective: 06/22/2020 Anticipated Recert Review: 1/31/2021 Program Location: Carone Hall, Basement and First Floor, 400 Sunrise Highway, , Amityville, New York 11701 Service Type: Outpatient Service (822) PRU: 50697 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Outpatient Substance Use Disorder Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10634_Northw.pdf
Certificate Number: 210111424 Establishment Effective: 02/19/2020 Anticipated Recert Review: 1/31/2021 Program Location: Jennings Hall, 1st Floor, 400 Sunrise Highway, Amityville, New York 11701 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50696 Certified Capacity: 28
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11424_Northw.pdf
Certificate Number: 210111489 Establishment Effective: 02/19/2020 Anticipated Recert Review: 1/31/2021 Program Location: Jennings Hall, 2nd Floor, 400 Sunrise Highway, Amityville, New York 11701 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 50695 Certified Capacity: 24 [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11489_Northw.pdf
Northwell Healthcare, Inc. as Sponsor, John T. Mather Hospital of Port Jefferson, New York, Inc. as Operator Provider Number: 83220 Mr. Kenneth Roberts, President Telephone - (631)-473-1320 Ext 4215 Administrative Office: 75 North Country Road, Port Jefferson, NY 11777
Certificate Number: 240810840 Renewal Effective: 09/01/2021 Anticipated Recert Review: 8/31/2024 Program Location: 1st Floor, 100 Highlands Boulevard, , Port Jefferson, New York 11777 Service Type: Outpatient Service (822) PRU: 50023 Certified Capacity: with Telepractice Designation
Program Name: Mather Outpatient Chemical Dependence Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10840_Northw.pdf
Northwell Healthcare, Inc. as Sponsor, Long Island Jewish Medical Center as Operator Provider Number: 85210 Carolyn Sweetapple Ph.D., Executive Director Telephone - (718)-470-4887 Administrative Office: ACP Suite 2309, 75-59 263rd Street, Glen Oaks, NY 11004
Certificate Number: 221010450 Amendment Effective: 05/28/2020 Anticipated Recert Review: 10/31/2022 Program Location: (Clinic) 75-59 263rd Street, 1st Floor, Glen Oaks, NY 11004-1150 , (Billing), 270-05 76th Avenue, , New Hyde Park, New York 11040 Service Type: Opioid Treatment Program (822) PRU: 307 Certified Capacity: 375 with Telepractice Designation [with ancillary withdrawal services for up to 38 patients] Capacity Lifted Program Name:
September 21, 2021 Page 146 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10450_Northw.pdf
Certificate Number: 211010557 Amendment Effective: 05/28/2020 Anticipated Recert Review: 10/31/2021 Program Location: 1st Floor Suite 160 and 2, 600 Hempstead Turnpike, , West Hempstead, New York 11552 Service Type: Outpatient Service (822) PRU: 431 Certified Capacity: with Telepractice Designation
Program Name: Project Outreach
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10557_Northw.pdf
Certificate Number: 221010639 Amendment Effective: 05/28/2020 Anticipated Recert Review: 10/31/2022 Program Location: 2nd Floor, 1600 Central Avenue, Far Rockaway, New York 11691 Service Type: Outpatient Service (822) PRU: 50021 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10639_Northw.pdf
Certificate Number: 221010855 Amendment Effective: 05/28/2020 Anticipated Recert Review: 10/31/2022 Program Location: (Clinic) 75-59 263rd Street, Basement, Glen Oaks, New York 11004-1150, (Billing), 270-05 76th Avenue, , New Hyde Park, New York 11040 Service Type: Outpatient Service (822) PRU: 3089 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10855_Northw.pdf
Certificate Number: 221010858 Amendment Effective: 05/28/2020 Anticipated Recert Review: 10/31/2022 Program Location: 711 Stewart Avenue, , Garden City, New York 11530 Service Type: Outpatient Service (822) PRU: 50064 Certified Capacity: with Telepractice Designation
Program Name: Garden City Treatment Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10858_Northw.pdf
Northwell Healthcare, Inc. as Sponsor, Staten Island University Hospital as Operator Provider Number: 85200 Brahim Ardolic M.D., Executive Director Telephone - (718)-226-9761 Administrative Office: 475 Seaview Avenue, Staten Island, NY 10305
Certificate Number: 221110290 Amendment Effective: 05/10/2021 Anticipated Recert Review: 11/30/2022 Program Location: Main Hospital Building, 2nd Floor, West Wing, 3rd Floor, North Wing, 375 Seguine Avenue, Staten Island, New York 10309 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 6975 Certified Capacity: 44 "without the use of methadone"
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10290_Northw.pdf
September 21, 2021 Page 147 of 225 Certificate Number: 221210446 Amendment Effective: 03/10/2021 Anticipated Recert Review: 12/31/2022 Program Location: 111 Water Street, Staten Island, New York 10304 Service Type: Opioid Treatment Program (822) PRU: 944 Certified Capacity: 220 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10446_Northw.pdf
Certificate Number: 211010447 Amendment Effective: 03/10/2021 Anticipated Recert Review: 10/31/2021 Program Location: Methadone Annex, 1st & 2nd Floors, 392 Seguine Avenue, , Staten Island, New York 10309 Service Type: Opioid Treatment Program (822) PRU: 304 Certified Capacity: 550 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10447_Northw.pdf
Certificate Number: 211010449 Amendment Effective: 03/10/2021 Anticipated Recert Review: 10/31/2021 Program Location: 1st Floor, 567 East 105th Street, , Brooklyn, New York 11236 Service Type: Opioid Treatment Program (822) PRU: 7150 Certified Capacity: 400 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10449_Northw.pdf
Certificate Number: 221011027 Amendment Effective: 03/10/2021 Anticipated Recert Review: 10/31/2022 Program Location: Original Building, North & South Wings, 2nd Floor, 392 Seguine Avenue, Staten Island, New York 10309 Service Type: Outpatient Service (822) PRU: 51422 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11027_Northw.pdf
Certificate Number: 221011406 Renewal Effective: 11/01/2019 Anticipated Recert Review: 10/31/2022 Program Location: Main Hospital Building, 3rd Floor, North Wing, 375 Seguine Avenue, Staten Island, New York 10309 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51623 Certified Capacity: 24
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11406_Northw.pdf
Ocean Recovery East, LLC d/b/a Ascendant New York Provider Number: 49900 Mr. Tzvi Heber, CEO Telephone - (917)-262-0003 Administrative Office: 113 East 60th Street, New York, NY 10022
September 21, 2021 Page 148 of 225 Certificate Number: 221212126 Amendment Effective: 11/30/2020 Anticipated Recert Review: 12/31/2022 Program Location: Floors 1-6, 113 East 60th Street, New York, New York 10022 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 53204 Certified Capacity: 15 with Telepractice Designation [up to 6 of these beds may be used for the provision of inpatient rehabilitation services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12126_OceanR.pdf
Certificate Number: 201212220 Amendment Effective: 10/02/2020 Anticipated Recert Review: 12/31/2020 Program Location: Basement, Rooms 005, 006, 007, 010, 1st Floor, Rooms 102, 107, 113 East 60th Street, , New York, New York 10022 Service Type: Outpatient Service (822) PRU: 53264 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12220_OceanR.pdf
Certificate Number: 211012243 Establishment Effective: 11/30/2020 Anticipated Recert Review: 10/31/2021 Program Location: 5th & 6th Floors, 113 East 60th Street, , New York, New York 10022 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53520 Certified Capacity: 3
Program Name: Ascendant NY
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12243_OceanR.pdf
Oceanside Counseling Center, Inc. Provider Number: 11500 Ms Teresa Maguire, Director Telephone - (516)-766-6283 Ext 14 Administrative Office: 71 Homecrest Court, Oceanside, NY 11572
Certificate Number: 210810910 Amendment Effective: 06/22/2020 Anticipated Recert Review: 8/31/2021 Program Location: School Building 6, 2nd Floor, 71 Homecrest Court, , Oceanside, New York 11572 Service Type: Outpatient Service (822) PRU: 6438 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10910_Oceans.pdf
Odyssey House, Inc. Provider Number: 19400 Peter Provet Ph.D., President and Chief Executive Telephone - (212)-361-1617 Administrative Office: Officer 17th Floor, 120 Wall Street, New York, NY 10005
Certificate Number: 181210052 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 219-233 East 121st Street, New York, New York 10035 Service Type: Intensive Residential Rehabilitation (819) PRU: 6817 Certified Capacity: 196
Program Name: Odyssey Manor
September 21, 2021 Page 149 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10052_Odysse.pdf
Certificate Number: 181210053 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Basement, 1st-4th Floors, 309-311 East 6th Street, New York, New York 10003 Service Type: Intensive Residential Rehabilitation (819) PRU: 957 Certified Capacity: 60
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10053_Odysse.pdf
Certificate Number: 181210055 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: George Rosenfeld Center for Recovery, 13 Hell Gate Circle, Ward's Island, New York 10035 Service Type: Intensive Residential Rehabilitation (819) PRU: 52848 Certified Capacity: 97
Program Name: Odyssey Ward's Island
Service Type: Intensive Residential Rehabilitation (819) PRU: 53066 Certified Capacity: 74 and up to 60 beds for children Program Name: Odyssey Ward's Island
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10055_Odysse.pdf
Certificate Number: 210611460 Amendment Effective: 08/25/2020 Anticipated Recert Review: 6/30/2021 Program Location: Suite 301, 3rd Floor, 953 Southern Boulevard, Bronx, New York 10459 Service Type: Outpatient Service (822) PRU: 7392 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11460_Odysse.pdf
Certificate Number: 190411582 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 4/30/2019 Program Location: 1264 Lafayette Avenue, Bronx, New York 10474 Service Type: Intensive Residential Rehabilitation (819) PRU: 52056 Certified Capacity: 16
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11582_Odysse.pdf
Certificate Number: 200811793 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 8/31/2020 Program Location: 1328 Clinton Avenue, 1322, 1326 &, Bronx, New York 10456 Service Type: Community Residential (819) PRU: 52659 Certified Capacity: 57 and up to 14 beds for children Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11793_Odysse.pdf
One Brooklyn Health System, Inc. as Active Parent and Co-Operator, Brookdale Hospital as Co-Operator Provider Number: 85470 Ms LaRay Brown, President/CEO Telephone - (718)-613-4001 Administrative Office: 1545 Atlantic Avenue, Brooklyn, NY 11213
September 21, 2021 Page 150 of 225 Certificate Number: 211210300 Establishment Effective: 01/01/2021 Anticipated Recert Review: 12/31/2021 Program Location: 6 East, 1545 Atlantic Avenue, Brooklyn, New York 11213 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 50586 Certified Capacity: 20 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10300_OneBro.pdf
Certificate Number: 211210457 Establishment Effective: 01/01/2021 Anticipated Recert Review: 12/31/2021 Program Location: 880 Bergen Street, , Brooklyn, New York 11238 Service Type: Opioid Treatment Program (822) PRU: 335 Certified Capacity: 450 with Telepractice Designation
Program Name: Interfaith Medical MMPT Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10457_OneBro.pdf
Certificate Number: 211210834 Establishment Effective: 01/01/2021 Anticipated Recert Review: 12/31/2021 Program Location: 3rd Floor, 1545 Atlantic Avenue, Brooklyn, New York 11213 Service Type: Outpatient Service (822) PRU: 50587 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 53012 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10834_OneBro.pdf
Certificate Number: 211211371 Establishment Effective: 01/01/2021 Anticipated Recert Review: 12/31/2021 Program Location: 6 West, 1545 Atlantic Avenue, Brooklyn, New York 11213 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 7038 Certified Capacity: 20 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11371_OneBro.pdf
Onondaga-Cortland-Madison BOCES Provider Number: 36380 Mr. Phil Grome, Assistant Superintendent for Telephone - (315)-433-2614 Administrative Office: Administration 110 Elwood Davis Road, Syracuse, NY 13121
Certificate Number: 220612014 Renewal Effective: 07/01/2019 Anticipated Recert Review: 6/30/2022 Program Location: Administrative Site Only:, 110 Elwood Davis Road, , Syracuse, New York 13121 Service Type: Prevention Counseling PRU: 90696 Certified Capacity:
Program Name:
St. Rose of Lima School, 411 South Main Street, North Syracuse, NY 13212 Other Service Site(s) At:
September 21, 2021 Page 151 of 225 Immaculate Conception School, 400 Salt Springs Road, Fayetteville, NY 13066 Other Service Site(s) At: Bishop Ludden, 815 Fay Road, Syracuse, NY 13219 Other Service Site(s) At: St. Mary's Academy, 49 Syracuse Street, Baldwinsville, NY 13027 Other Service Site(s) At: Most Holy Rosary School, 1031 Bellevue Avenue, Syracuse, NY 13207 Other Service Site(s) At: Blessed Sacrament School, 3129 James Street, Syracuse, NY 13206 Other Service Site(s) At: Bishop Grimes JHS, 6653 Kirkville Road, East Syracuse, NY 13057 Other Service Site(s) At: St. Margaret's School, 200 Roxboro Road, Mattydale, NY 13211 Other Service Site(s) At: Our Lady of Pompei School, 923 North McBride Street, Syracuse, NY 13208 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12014_Ononda.pdf
Open Arms, Incorporated Provider Number: 34360 Ms. Barbara Swift, Executive Director Telephone - (845)-271-3787 Administrative Office: 57-59 Sharp Street, Haverstraw, NY 10927
Certificate Number: 181210119 Conditional Certificate Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 57-59 Sharp Street, Haverstraw, New York 10927 Service Type: Community Residential (819) PRU: 50943 Certified Capacity: 18
Program Name: Open Arms Halfway House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10119_OpenAr.pdf
Certificate Number: 181211472 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 57-59 Sharp Street, Haverstraw, New York 10927 Service Type: Supportive Living (819) PRU: 51524 Certified Capacity: 20
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11472_OpenAr.pdf
Certificate Number: 181211771 Conditional Certificate Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 74 Hudson Avenue, , Haverstraw, New York 10927 Service Type: Community Residential (819) PRU: 52613 Certified Capacity: 12
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11771_OpenAr.pdf
Osborne Treatment Services, Inc. Provider Number: 1879 Ms. Elizabeth Gaynes, President/CEO Telephone - (718)-707-2600 Administrative Office: 809 Westchester Avenue, Bronx, NY 10455
September 21, 2021 Page 152 of 225 Certificate Number: 240511272 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2024 Program Location: Basement, 1st-3rd Floors, 809 Westchester Avenue, Bronx, New York 10455 Service Type: Outpatient Service (822) PRU: 7323 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11272_Osborn.pdf
Oswego County Opportunities, Inc. Provider Number: 40660 Ms. Diane Cooper-Currier, Executive Director Telephone - (315)-598-4717 Ext 1017 Administrative Office: 239 Oneida Street, Fulton, NY 13069
Certificate Number: 190810186 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 8/31/2019 Program Location: 239 Oneida Street, RECORDS ONLY are located at:, Fulton, New York 13069-1228, 53 Hall Road, R.D. #1, Hannibal, New York 13074 Service Type: Supportive Living (819) PRU: 51425 Certified Capacity: 10
Program Name: Arbor House Supportive Living Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10186_Oswego.pdf
Certificate Number: 181210187 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 53 Hall Road, Hannibal, New York 13074 Service Type: Community Residential (819) PRU: 50966 Certified Capacity: 16
Program Name: Arbor House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10187_Oswego.pdf
Otsego County Community Services Board Provider Number: 70120 Ms. Susan Matt, LCSW-R, CASAC, Director Telephone - (607)-433-2343 Administrative Office: 3rd Floor, 242 Main Street, Oneonta, NY 13820
Certificate Number: 221210917 Amendment Effective: 07/10/2020 Anticipated Recert Review: 12/31/2022 Program Location: Otsego County Satellite Office Building, 2nd Floor, 242 Main Street, Oneonta, New York 13820 Service Type: Outpatient Service (822) PRU: 50325 Certified Capacity: with Telepractice Designation
Program Name: Otsego County Community Services Chemical Dependencies Clinic
140 County Highway 33W, Cooperstown, NY 13326 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10917_Otsego.pdf
Our Lady of Lourdes Memorial Hospital Provider Number: 82150 Ms. Kathryn Connerton, Chief Executive Officer Telephone - (607)-798-5334 Administrative Office: 169 Riverside Drive, Binghamton, NY 13905
September 21, 2021 Page 153 of 225 Certificate Number: 181211968 Amendment Effective: 07/27/2018 Anticipated Recert Review: 12/31/2018 Program Location: Administrative Site Only:, 184 Court Street, Binghamton, New York 13901 Service Type: Prevention Counseling PRU: 90733 Certified Capacity:
Program Name:
Deposit High School, 1st Floor, Guidance Office, 171 2nd Street, Deposit, NY 13754 Other Service Site(s) At: Chenango Forks High School, 1st Floor, Room 100-1, 1 Gordon Drive, Binghamton, NY 13901 Other Service Site(s) At: Maine-Endwell High School, 1st Floor, Room 116.3, 750 Farm to Market Road, Endwell, NY 13760 Other Service Site(s) At: Chenango Valley High School, 2nd Floor, Guidance Office, 221 Chenango Bridge Road, Binghamton, NY 13901 Other Service Site(s) At: Whitney Point High School, 1st Floor, Guidance Suite, 10 Keibel Road, Whitney Point, NY 13862 Other Service Site(s) At: Leslie F. Distin Education Center BOCES, 435 Glenwood Road, Binghamton, NY 13905 Other Service Site(s) At: Maine-Endwell Middle School, 1st Floor, Room #142, 1119 Farm To Market Road, Endwell, NY 13760 Other Service Site(s) At: Binghamton High School, 3rd Floor, Room A307, 31 Main Street, Binghamton, NY 13905 Other Service Site(s) At: Johnson City Middle School, Room 114D, 601 Columbia Drive, Johnson City, NY 13790 Other Service Site(s) At: Seton Catholic Central High School, Main Level, Guidance Office, 70 Seminary Avenue, Binghamton, NY 13905 Other Service Site(s) At: Windsor High School, Upper Level, Guidance Office, 1191 Route 79, Windsor, NY 13865 Other Service Site(s) At: Broome-Tioga BOCES East Learning Center (Columbus), 2nd Floor, Room 200B, 164 Hawley Street, Binghamton, NY 13901 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11968_OurLad.pdf
Outreach Development Corporation Provider Number: 31360 Ms. Debra Pantin, President/CEO Telephone - (718)-847-9233 Ext 2232 Administrative Office: Richmond Hill Building, 2nd Floor, 117-11 Myrtle Avenue, Richmond Hill, NY 11418
Certificate Number: 211110561 Amendment Effective: 04/22/2020 Anticipated Recert Review: 11/30/2021 Program Location: Unit C and D, 1st Floor, 11 Farber Drive, , Bellport, New York 11713 Service Type: Outpatient Service (822) PRU: 6594 Certified Capacity: with Telepractice Designation
Program Name: Outreach Project - Bellport Service Type: Outpatient Rehabilitation Service (822) PRU: 6635 Certified Capacity: with Telepractice Designation
Program Name: Outreach Project - Bellport
September 21, 2021 Page 154 of 225 OTI Building, 1st Floor, Office #2 and Conference Room #2, 400 Crooked Hill Road, Brentwood, NY 11717 Additional Location(s) At: Eastern Suffolk BOCES-Bellport Academic Center, 350 Martha Avenue, Bellport, NY 11713 Additional Location(s) At: Longwood High School, 100 Longwood Road, Middle Island, NY 11953 Additional Location(s) At:
Mercy First -Syosset Campus, 525 Convent Road, Syosset, NY 11791 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10561_Outrea.pdf
Certificate Number: 201110563 Amendment Effective: 04/22/2020 Anticipated Recert Review: 11/30/2020 Program Location: Basement, 1st and 2nd Floors, 117-11 Myrtle Avenue, Richmond Hill, New York 11418 Service Type: Outpatient Service (822) PRU: 7210 Certified Capacity: with Telepractice Designation
Program Name: The Outreach Project
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10563_Outrea.pdf
Certificate Number: 221211273 Amendment Effective: 04/22/2020 Anticipated Recert Review: 12/31/2022 Program Location: 2nd & 3rd Floors, 960 Manhattan Avenue, Brooklyn, New York 11222 Service Type: Outpatient Service (822) PRU: 51847 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11273_Outrea.pdf
Certificate Number: 211011790 Amendment Effective: 04/22/2020 Anticipated Recert Review: 10/31/2021 Program Location: 452 Suffolk Avenue, Brentwood, New York 11717 Service Type: Outpatient Service (822) PRU: 52648 Certified Capacity: with Telepractice Designation
Program Name:
Pilgrim Psychiatric Center-Building #56, Western Suffolk Clinic - Building #56, 998 Crooked Hill Road, Brentwood, NY 11717 Additional Location(s) At: Pilgrim Psychiatric Center, Buckman Clinic - Building #47, 998 Crooked Hill Road, Brentwood, NY 11717 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11790_Outrea.pdf
Certificate Number: 240212031 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/29/2024 Program Location: and Basement, 1st-3rd Floors, 16-14 Weirfield Street, Ridgewood, New York 11385 Service Type: Residential Rehabilitation Services for Youth (817) PRU: 53003 Certified Capacity: 30
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12031_Outrea.pdf
September 21, 2021 Page 155 of 225 Certificate Number: 201012032 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 10/31/2020 Program Location: 400 Crooked Hill Road, Brentwood, New York 11717 Service Type: Residential Rehabilitation Services for Youth (817) PRU: 53002 Certified Capacity: 45
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10093_Outrea.pdf
Certificate Number: 210612076 Amendment Effective: 01/25/2021 Anticipated Recert Review: 6/30/2021 Program Location: Pilgrim Psychiatric Center, Building #5, 1st and 2nd Floors, 998 Crooked Hill Road, , Brentwood, New York 11717 Service Type: Outpatient Service (822) PRU: 53093 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12076_Outrea.pdf
Certificate Number: 201212219 Amendment Effective: 04/22/2020 Anticipated Recert Review: 12/31/2020 Program Location: 27A Washington Place, , Roosevelt, New York 11575 Service Type: Outpatient Service (822) PRU: 53483 Certified Capacity: with Telepractice Designation
Program Name: Outreach's REACT Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12219_Outrea.pdf
Certificate Number: 201212221 Establishment Effective: 01/15/2020 Anticipated Recert Review: 12/31/2020 Program Location: Building #4, 400 Crooked Hill Road, , Brentwood, New York 11717 Service Type: Residential Services (820) PRU: 53263 Certified Capacity: 25
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Outreach's Recovery Residence for Women
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12221_Outrea.pdf
Certificate Number: 220412264 Establishment Effective: 05/07/2021 Anticipated Recert Review: 4/30/2022 Program Location: Pilgrim Psychiatric Center, Building #5, 1st and 2nd Floors, 998 Crooked Hill Road, , Brentwood, New York 11717 Service Type: Residential Services (820) PRU: 53558 Certified Capacity: 36
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12264_Outrea.pdf
The PAC Program of the Bronx, Inc. Provider Number: 47080 Ms. Maria Mendez, Executive Vice President/COO Telephone - (718)-328-2605 Administrative Office: 1215-1217 Stratford , Bronx, NY 10472
September 21, 2021 Page 156 of 225 Certificate Number: 221211691 Amendment Effective: 06/05/2020 Anticipated Recert Review: 12/31/2022 Program Location: 1215-1217 Stratford Avenue, Bronx, New York 10472 Service Type: Outpatient Service (822) PRU: 52233 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Service (822) PRU: 52233 Certified Capacity: with Telepractice Designation
Program Name:
11th Floor, 15 West 39th Street, New York, NY 10018 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11691_PACPro.pdf
Parallax Center, Inc. Provider Number: 1898 David Ockert Ph.D., Executive Director Telephone - (212)-779-9207 Administrative Office: 6th Floor, 145 East 32nd Street, New York, NY 10016
Certificate Number: 210510500 Renewal Effective: 06/01/2018 Anticipated Recert Review: 5/31/2021 Program Location: 6th Floor, 145 East 32nd Street, New York, New York 10016 Service Type: Medically Supervised Outpatient Withdrawal & Stabilization (816.8) PRU: 8020 Certified Capacity: 25 [without the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10500_Parall.pdf
Certificate Number: 220710920 Amendment Effective: 09/01/2020 Anticipated Recert Review: 7/31/2022 Program Location: 6th Floor, 145 East 32nd Street, New York, New York 10016 Service Type: Outpatient Service (822) PRU: 5513 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10920_Parall.pdf
Pearl Street Counseling Center, Inc. Provider Number: 651 Mr. Guy Kuperman, Executive Director Telephone - (518)-462-4320 Administrative Office: 1st Floor, 109 State Street, Albany, NY 12207
Certificate Number: 210611525 Renewal Effective: 07/01/2019 Anticipated Recert Review: 6/30/2021 Program Location: 1st Floor, 109 State Street, Albany, New York 12207 Service Type: Outpatient Service (822) PRU: 1694 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11525_PearlS.pdf
September 21, 2021 Page 157 of 225 Phoenix Houses of Long Island, Inc. Provider Number: 50570 Ms. Ann Marie M. Foster, President and CEO Telephone - (718)-222-6673 Administrative Office: 34-11 Vernon Boulevard, Long Island City, NY 11106
Certificate Number: 181211308 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 220 Veterans Memorial Highway, Hauppauge, New York 11788 Service Type: Intensive Residential Rehabilitation (819) PRU: 2013 Certified Capacity: 65 with Telepractice Designation
Program Name: Phoenix House Hauppauge Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11308_Phoeni.pdf
Certificate Number: 181211310 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 95 Industrial Road, Wainscott, New York 11975 Service Type: Intensive Residential Rehabilitation (819) PRU: 6298 Certified Capacity: 45 with Telepractice Designatioin
Program Name: Phoenix House Academy of Long Island
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11310_Phoeni.pdf
Certificate Number: 231011778 Renewal Effective: 11/01/2020 Anticipated Recert Review: 10/31/2023 Program Location: 287 Springs-Fireplace Road, East Hampton, New York 11937 Service Type: Outpatient Service (822) PRU: 52627 Certified Capacity: with Telepractice Designation
Program Name: East Hampton Outpatient Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11778_Phoeni.pdf
Certificate Number: 200112080 Extended Establishmen Effective: 02/01/2019 Anticipated Recert Review: 1/31/2020 Program Location: Basement, 1st-5th Floors, 34-25 Vernon Boulevard, Long Island City, New York 11106 Service Type: Residential Services (820) PRU: 53073 Certified Capacity: 190 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12080_Phoeni.pdf
Certificate Number: 200212155 Conversion Effective: 03/04/2019 Anticipated Recert Review: 2/29/2020 Program Location: 153, 153A, and 161 Lake Shore Road, , Lake Ronkonkoma, New York 11779 Service Type: Residential Services (820) PRU: 53273 Certified Capacity: 96 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Phoenix House - Lake Ronkonkoma
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12155_Phoeni.pdf
September 21, 2021 Page 158 of 225 Certificate Number: 220112184 Amendment Effective: 06/10/2020 Anticipated Recert Review: 1/31/2022 Program Location: 1st Floor, 34-11 Vernon Boulevard, , Long Island City, New York 11106 Service Type: Outpatient Service (822) PRU: 53318 Certified Capacity: with Telepractice Designation
Program Name: Parkside Outpatient Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12184_Phoeni.pdf
Postgraduate Center for Mental Health Provider Number: 18270 Mr. Jacob Barak, CEO Telephone - (212)-899-5500 Ext 205 Administrative Office: 158 East 35th Street, New York, NY 10016
Certificate Number: 220512190 Conditional Certificate OASAS Host Effective: 06/01/2021 Anticipated Recert Review: 5/31/2022 Program Location: 8th Floor, 1775 Grand Concourse, , Bronx, New York 10453 Service Type: Outpatient Service (822) PRU: 53437 Certified Capacity: with Telepractice Designation
Program Name: Bronx Recovery Support Center Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12190_Postgr.pdf
PRCD, Inc. Provider Number: 37360 Ms Mandy Teeter, Vice President, Rochester Telephone - (585)-922-5497 Administrative Office: Regional Health-Behavioral Health 3rd Floor, 81 Lake Avenue, Rochester, NY 14608
Certificate Number: 181210266 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 2650 Ridgeway Avenue, Rochester, New York 14626 Service Type: Community Residential (819) PRU: 51037 Certified Capacity: 24 for women and with Telepractice Designation
Program Name: Barbara Wolk Schwarz Women Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10266_PRCDIn.pdf
The Prevention Council of Erie County, Inc. Provider Number: 38040 Ms. Robin Mann, Executive Director Telephone - (716)-831-2298 Administrative Office: 1625 Hertel Avenue, Buffalo, NY 14216
Certificate Number: 211112001 Amendment Effective: 02/03/2020 Anticipated Recert Review: 11/30/2021 Program Location: 1st Floor, 1625 Hertel Avenue, Buffalo, New York 14216 Service Type: Prevention Counseling PRU: 90711 Certified Capacity:
Program Name: Student Assistance Prevention Counseling Program
School #66 - North Park Middle Academy, Guidance Office, 780 Parkside Avenue, Buffalo, NY 14216 Other Service Site(s) At:
September 21, 2021 Page 159 of 225 Lackawanna High/Middle School, Guidance Office, 550 Martin Road, Lackawanna, NY 14218 Other Service Site(s) At: Bennett High School, 2885 Main Street, Buffalo, NY 14214 Other Service Site(s) At: Enterprise Charter School, 1st Floor, Social Worker's Office, 275 Oak Street, Buffalo, NY 14203 Other Service Site(s) At: East High School, 820 Northampton Avenue, Buffalo, NY 14211 Other Service Site(s) At: McKinley High School, Room 210, 1500 Elmwood Avenue, Buffalo, NY 14207 Other Service Site(s) At: Riverside Institute of Technology, Room 131, 51 Ontario Street, Buffalo, NY 14215 Other Service Site(s) At: School #18, Room 316, 118 Hampshire Street, Buffalo, NY 14213 Other Service Site(s) At: School # 19 - Native American Magnet, 2nd Floor, Room 210, 238 Ontario Street, Buffalo, NY 14207 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12001_ErieCo.pdf
Professional Counseling Services, Inc. Provider Number: 49850 Ms. Darlene Angelicchio, President Telephone - (315)-488-1641 Administrative Office: Medical Center West, Suite #118, 1st Floor, 5700 West Genesee Street, Camillus, NY 13031
Certificate Number: 220112121 Amendment Effective: 05/04/2020 Anticipated Recert Review: 1/31/2022 Program Location: Medical Center West, Suite #118, 1st Floor, 5700 West Genesee Street, , Camillus, New York 13031 Service Type: Outpatient Service (822) PRU: 53177 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12121_Profes.pdf
Project Hospitality, Inc. Provider Number: 19900 Ms. Jaclyn Stoll, Interim Executive Director Telephone - (718)-448-1544 Ext 110 Administrative Office: 100 Park Avenue, Staten Island, NY 10302
Certificate Number: 201110948 Amendment Effective: 01/01/2018 Anticipated Recert Review: 11/30/2020 Program Location: 14 Slosson Terrace, Staten Island, New York 10301 Service Type: Outpatient Service (822) PRU: 51157 Certified Capacity: with Telepractice Designation
Program Name:
New York City Administration for Children's Services, 3rd and 5th Floors, 350 St. Mark's Place, Staten Island, NY 10301 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10948_Projec.pdf
September 21, 2021 Page 160 of 225 Certificate Number: 200912148 Conditional Certificate Effective: 04/01/2020 Anticipated Recert Review: 9/30/2020 Program Location: Bayley Seton Campus, 1st Floor - F Wing, 75 Vanderbilt Avenue, Staten Island, New York 10304 Service Type: Residential Services (820) PRU: 53232 Certified Capacity: 20
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: PREP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12148_Projec.pdf
Project Renewal, Inc. Provider Number: 50470 Mr. Eric Rosenbaum, President & Chief Executive Telephone - (212)-620-0340 Administrative Office: Officer 9th Floor, 200 Varick Street, New York, NY 10014
Certificate Number: 181210196 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 4th Floor, Eight East Third Street, New York, New York 10003 Service Type: Medically Monitored Withdrawal & Stabilization Services (816.9) PRU: 51112 Certified Capacity: 30 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10196_Projec.pdf
Certificate Number: 210910949 Amendment Effective: 06/05/2020 Anticipated Recert Review: 9/30/2021 Program Location: 1st Floor, 8 East Third Street, New York, New York 10003 Service Type: Outpatient Service (822) PRU: 50052 Certified Capacity: with Telepractice Designation
Program Name: Project Renewal Chemical Dependence Outpatient Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10949_Projec.pdf
Certificate Number: 210211600 Emergency Effective: 10/21/2020 Anticipated Recert Review: 2/17/2021 Program Location: 2nd & 3rd Floors, 8 East Third Street, , New York, New York 10003 Service Type: Medically Supervised Outpatient Withdrawal & Stabilization (816.8) PRU: 52081 Certified Capacity: 30 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11600_Projec.pdf
Certificate Number: 210112224 Amendment Effective: 11/19/2020 Anticipated Recert Review: 1/31/2021 Program Location: 2nd Floor, 179 East 116th Street, , New York, New York 10029 Service Type: Outpatient Service (822) PRU: 53475 Certified Capacity: with Telepractice Designation
Program Name: Project Renewal Support and Connection Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
September 21, 2021 Page 161 of 225 Putnam Family and Community Services, Inc. d/b/a CoveCare Center Provider Number: 27700 Mr. Eric Toth, Chief Executive Officer Telephone - (845)-225-2700 Ext 246 Administrative Office: 1808 Route Six, Carmel, NY 10512
Certificate Number: 211210952 Amendment Effective: 09/04/2020 Anticipated Recert Review: 12/31/2021 Program Location: 1808 Route Six, Carmel, New York 10512 Service Type: Outpatient Service (822) PRU: 50422 Certified Capacity: with Telepractice Designation
Program Name: Chemical Dependency Treatment Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10952_Putnam.pdf
Q.S.A. Services Incorporated d/b/a The PAC Program of Queens Provider Number: 44510 Ms. Jordania Estrella, Chief Operating Officer Telephone - (212)-837-2013 Administrative Office: 40-11 Warren Street, Elmhurst, NY 11373
Certificate Number: 240511491 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2024 Program Location: 40-11 Warren Street, Elmhurst, New York 11373 Service Type: Outpatient Service (822) PRU: 51997 Certified Capacity: with Telepractice Designation
Program Name: The PAC Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11491_QSASer.pdf
The REACH Project, Inc. Provider Number: 51440 Justine Waldman M.D., CEO Telephone - (607)-273-7000 Administrative Office: 1001 W. Seneca Street, Ithaca, NY 14850
Certificate Number: 210712234 Amendment Effective: 03/05/2021 Anticipated Recert Review: 7/31/2021 Program Location: 1st Floor, 1001 W. Seneca Street, , Ithaca, New York 14850 Service Type: Outpatient Service (822) PRU: 53498 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12234_TheREA.pdf
Reality House, Inc. Provider Number: 19660 Mr. Hewitt DePass, Executive Director Telephone - (212)-281-6004 Ext 302 Administrative Office: 8-13 Astoria Boulevard, Astoria, NY 11102
Certificate Number: 220711685 Amendment Effective: 05/29/2020 Anticipated Recert Review: 7/31/2022 Program Location: 8-13 Astoria Boulevard, Astoria, New York 11102 Service Type: Outpatient Service (822) PRU: 52219 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11685_Realit.pdf
September 21, 2021 Page 162 of 225 Certificate Number: 181211799 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 8-13 Astoria Boulevard, Astoria, New York 11102 Service Type: Community Residential (819) PRU: 52642 Certified Capacity: 30 with Telepractice Designation
Program Name: Reality House Veterans Community Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11799_Realit.pdf
Realization Center, Inc. Provider Number: 27270 Ms. Marilyn J. White, Executive Director and Chief Telephone - (212)-627-9600 Administrative Office: Executive Officer 7th Floor, 19 Union Square West, New York, NY 10003
Certificate Number: 220210955 Amendment Effective: 11/19/2020 Anticipated Recert Review: 2/28/2022 Program Location: 7th Floor, 19 Union Square West, New York, New York 10003 Service Type: Outpatient Service (822) PRU: 7073 Certified Capacity: [with ancillary withdrawal services] with Telepractice Designation
Program Name: Realization Center Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10955_Realiz.pdf
Certificate Number: 221011350 Renewal Effective: 11/01/2020 Anticipated Recert Review: 10/31/2022 Program Location: 2nd Floor, 175 Remsen Street, Brooklyn, New York 11201 Service Type: Outpatient Service (822) PRU: 7393 Certified Capacity: [with ancillary withdrawal services] with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11350_Realiz.pdf
Recovery Associates of Upstate New York, Inc. as Sponsor, East House Corporation as Operator Provider Number: 50410 Ms. Kim Brumber, President and Chief Executive Telephone - (585)-238-4823 Administrative Office: Officer Suite 200, 259 Monroe Avenue, Rochester, NY 14607
Certificate Number: 200210191 Amendment Effective: 01/03/2020 Anticipated Recert Review: 2/29/2020 Program Location: 259 Monroe Avenue, Rochester, New York 14607 Service Type: Supportive Living (819) PRU: 51260 Certified Capacity: 72 with Telepractice Designation and up to 12 beds for children Program Name: Crossroads Apartment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10191_Recove.pdf
Certificate Number: 200210192 Establishment Effective: 03/21/2019 Anticipated Recert Review: 2/29/2020 Program Location: 109 Dartmouth Street, Rochester, New York 14607 Service Type: Community Residential (819) PRU: 50038 Certified Capacity: 12 with Telepractice Designation
Program Name: Hirst House
September 21, 2021 Page 163 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10192_Recove.pdf
Certificate Number: 200210193 Establishment Effective: 03/21/2019 Anticipated Recert Review: 2/29/2020 Program Location: 561 Mount Hope Avenue, Rochester, New York 14620 Service Type: Community Residential (819) PRU: 50037 Certified Capacity: 14 with Telepractice Designation
Program Name: Crossroads I, Hanson House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10193_Recove.pdf
Certificate Number: 200210194 Establishment Effective: 03/21/2019 Anticipated Recert Review: 2/29/2020 Program Location: 1st and 2nd Floors, Basement, 407 Frederick Douglass Street, Rochester, New York 14608 Service Type: Community Residential (819) PRU: 50039 Certified Capacity: 16 with Telepractice Designation
Program Name: Crossroads III, Cody House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10194_Recove.pdf
Certificate Number: 200210195 Establishment Effective: 03/21/2019 Anticipated Recert Review: 2/29/2020 Program Location: 50 Browncroft Boulevard, Rochester, New York 14609 Service Type: Community Residential (819) PRU: 51314 Certified Capacity: 12 with Telepractice Designation
Program Name: Browncroft House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10195_Recove.pdf
Regional Economic Community Action Program, Inc. Provider Number: 34070 Mr. Charles Quinn, Chief Executive Officer Telephone - (845)-421-6243 Administrative Office: 40 Smith Street, Middletown, NY 10940
Certificate Number: 190810116 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 8/31/2019 Program Location: Basement,, 1st & 2nd Floors, 127 Hickory Hill Road, Newburgh, New York 12550 Service Type: Community Residential (819) PRU: 50196 Certified Capacity: 24
Program Name: RECAP - New Life Halfway House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10116_Region.pdf
Certificate Number: 240611223 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2024 Program Location: 1st Floor, 40-48 Smith Street, Middletown, New York 10940 Service Type: Outpatient Rehabilitation Service (822) PRU: 50990 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11223_Region.pdf
September 21, 2021 Page 164 of 225 Rego Park Counseling LLC Provider Number: 51310 Mr Emanuil Kalendarev, Owner Telephone - (718)-496-3834 Administrative Office: 1st Floor, 6336 99th Street, Rego Park, NY 11374
Certificate Number: 210112223 Amendment Effective: 08/21/2020 Anticipated Recert Review: 1/31/2021 Program Location: 1st Floor, 6336 99th Street, , Rego Park, New York 11374 Service Type: Outpatient Service (822) PRU: 53489 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12223_RegoPa.pdf
Rehabilitation Support Services, Inc. Provider Number: 14370 Mr. William DeVita, Executive Director Telephone - (518)-464-1511 Administrative Office: 5172 Western Turnpike, Altamont, NY 12009
Certificate Number: 181211313 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Basement, 1st, 2nd & 3rd Floors, 11 Overbaugh Street, Saugerties, New York 12477 Service Type: Community Residential (819) PRU: 51242 Certified Capacity: 18
Program Name: Abel House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11313_Rehabi.pdf
Renaissance Addiction Services, Inc. Provider Number: 48530 Ms. Robin A. Clouden, Executive Director Telephone - (716)-827-9462 Administrative Office: 920 Harlem Road, West Seneca, NY 14224
Certificate Number: 210811830 Amendment Effective: 11/01/2018 Anticipated Recert Review: 8/31/2021 Program Location: 920 Harlem Road, West Seneca, New York 14224 Service Type: Residential Rehabilitation Services for Youth (817) PRU: 52733 Certified Capacity: 47
Program Name: Renaissance Addiction Services, Inc. (RASI)
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11830_Renais.pdf
Certificate Number: 220112164 Establishment Effective: 02/01/2021 Anticipated Recert Review: 1/31/2022 Program Location: 920 Harlem Road, , West Seneca, New York 14224 Service Type: Residential Services (820) PRU: 53536 Certified Capacity: 15
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Promise House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12164_Renais.pdf
Certificate Number: 220112179 Establishment Effective: 02/01/2021 Anticipated Recert Review: 1/31/2022 Program Location: 920 Harlem Road, , West Seneca, New York 14224 Service Type: Residential Services (820) PRU: 53537 Certified Capacity: 15
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Palmerton Place
September 21, 2021 Page 165 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Rensselaer County Department of Mental Health Provider Number: 70300 Ms. Katherine Alonge-Coons, Commissioner Telephone - (518)-270-2807 Administrative Office: County Office Building, 3rd Floor, 1600 7th Avenue, Troy, NY 12180
Certificate Number: 230312013 Renewal Effective: 04/01/2020 Anticipated Recert Review: 3/31/2023 Program Location: Ned Pattison Rensselaer County Government Center, 3rd Floor, 1600 7th Avenue, Troy, New York 12180 Service Type: Prevention Counseling PRU: 90821 Certified Capacity:
Program Name: Unified Services
Averill Park High School, 146 Gettle Road, Averill Park, NY 12018 Other Service Site(s) At: Rensselaer City School District, 3rd Floor , Room 303, 25 Van Rensselaer Drive, Rensselaer, NY 12144 Other Service Site(s) At: Columbia High School, 962 Luther Road, East Greenbush, NY 12061 Other Service Site(s) At: Berlin Middle/High School, 17400 Route 22, Cherry Plain, NY 12040 Other Service Site(s) At: Knickerbacker Middle/High School (Lansingburgh), 320 Seventh Avenue, Troy, NY 12182 Other Service Site(s) At: Algonquin Middle School, 1st Floor, Room 402, 333 NY Highway 351, Averill Park, NY 12018 Other Service Site(s) At: Goff Middle School, Office, 35 Gilligan Road, East Greenbush, NY 12061 Other Service Site(s) At: Troy High School, 1950 Burdett Avenue, Troy, NY 12180 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12013_Rensse.pdf
Renwick Recovery, Inc. Provider Number: 15510 Mr. Dominic P. Fata, Chief Executive Officer Telephone - (845)-569-0775 Administrative Office: 131 Mill Street, Newburgh, NY 12550
Certificate Number: 181210335 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 131 Mill Street, Newburgh, New York 12550 Service Type: Supportive Living (819) PRU: 51584 Certified Capacity: 40
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10335_Renwic.pdf
The Rescue Mission of Utica, N.Y. Provider Number: 36280 Mr. James Haid, Chief Executive Officer Telephone - (315)-735-1645 Ext 101 Administrative Office: 293 Genesee Street, Utica, NY 13501
September 21, 2021 Page 166 of 225 Certificate Number: 221212078 Renewal Effective: 01/01/2020 Anticipated Recert Review: 12/31/2022 Program Location: 210 Lansing Street, Utica, New York 13501 Service Type: Residential Services (820) PRU: 53101 Certified Capacity: 25
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12078_TheRes.pdf
Resource Recovery Center of Orange County, LLC Provider Number: 50790 Mr. Michael Bentson, Chief Executive Officer Telephone - (845)-209-3512 Ext 7011 Administrative Office: 68 Crystal Run Road, Middletown, NY 10941
Certificate Number: 231012181 Amendment Effective: 01/19/2021 Anticipated Recert Review: 10/31/2023 Program Location: 1st & 2nd Floors, 68 Crystal Run Road, , Middletown, New York 10941 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53323 Certified Capacity: 50
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12181_Resour.pdf
Certificate Number: 231012182 Amendment Effective: 01/19/2021 Anticipated Recert Review: 10/31/2023 Program Location: 1st Floor, 68 Crystal Run Road, , Middletown, New York 10941 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 53351 Certified Capacity: 24 [up to 22 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12182_Resour.pdf
The Resource Training Center Inc. Provider Number: 46430 Ms. AnnMarie Perrotto, President/CEO Telephone - (718)-605-1989 Ext 32 Administrative Office: 3rd Floor, 4521 Arthur Kill Road, Staten Island, NY 10309 d/b/a The Resource Counseling Center Certificate Number: 211011728 Renewal Effective: 11/01/2018 Anticipated Recert Review: 10/31/2021 Program Location: 2nd & 4th Floors, 449 39th Street, Brooklyn, New York 11232 Service Type: Outpatient Service (822) PRU: 52554 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
408 77th Street, Brooklyn, NY 11209 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11728_Resour.pdf
September 21, 2021 Page 167 of 225 d/b/a Christopher's Reason Certificate Number: 220412144 Renewal Effective: 05/01/2019 Anticipated Recert Review: 4/30/2022 Program Location: 3rd Floor, 4521 Arthur Kill Road, Staten Island, New York 10309 Service Type: Outpatient Service (822) PRU: 53241 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12144_Resour.pdf
Restorative Management Corp. Provider Number: 1617 Mr. Jeffrey Spitz LCSW, Executive Director Telephone - (845)-561-5783 Administrative Office: 7 Railroad Avenue, Middletown, NY 10940
Certificate Number: 230110960 Amendment Effective: 02/20/2020 Anticipated Recert Review: 1/31/2023 Program Location: Floor 2, 7 Railroad Avenue, Middletown, New York 10940 Service Type: Outpatient Service (822) PRU: 6377 Certified Capacity: 0 with Telepractice and Problem Gambling Designations
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10960_Restor.pdf
Certificate Number: 230210961 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/28/2023 Program Location: 172-178 Liberty Street, , Newburgh, New York 12550 Service Type: Outpatient Service (822) PRU: 7265 Certified Capacity: 0 with Telepractice and Program Gambling Designations
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10961_Restor.pdf
Certificate Number: 221211702 Amendment Effective: 02/20/2020 Anticipated Recert Review: 12/31/2022 Program Location: Suite #108, 123 Pike Street, , Port Jervis, New York 12771 Service Type: Outpatient Service (822) PRU: 52245 Certified Capacity: 0 with Telepractice and Problem Gambling Designations
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11702_Restor.pdf
RevCore Recovery Center of Manhattan, LLC Provider Number: 49130 Mr. Avraham Schick, Executive Director/CEO Telephone - (212)-966-9537 Administrative Office: 181 Canal Street, New York, NY 10013
Certificate Number: 230211949 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/20/2023 Program Location: 4th and 5th Floors, 181 Canal Street, New York, New York 10013 Service Type: Outpatient Service (822) PRU: 52928 Certified Capacity: 0 with Telepractice Designation
Program Name:
September 21, 2021 Page 168 of 225 Terence Cardinal Cooke Health Care Center (TCC), 4th Floor, Suite A-419, 1249 5th Avenue, New York, NY 10029 Additional Location(s) At: 3rd Floor, 15 Second Avenue, Brooklyn, NY 11215 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11949_RevCor.pdf
Certificate Number: 230211950 Renewal Effective: 03/01/2020 Anticipated Recert Review: 2/28/2023 Program Location: 3rd & 4th Floors, 37-20 74th Street, Jackson Heights, New York 11372 Service Type: Outpatient Service (822) PRU: 52929 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11950_RevCor.pdf
Richmond Medical Center d/b/a Richmond University Medical Center Provider Number: 45720 Mr. Daniel Messina, CEO Telephone - (718)-818-2400 Administrative Office: Active Parent Corporation: Bridge Regional Health System, Inc., 355 Bard Avenue, Staten Island, NY 10310
Certificate Number: 201211634 Amendment Effective: 07/01/2020 Anticipated Recert Review: 12/31/2020 Program Location: Silberstein Center, 2nd Floor, 1130 South Avenue, Staten Island, New York 10314 Service Type: Outpatient Service (822) PRU: 52125 Certified Capacity: with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]
Program Name: Service Type: Outpatient Service (822) PRU: 53050 Certified Capacity: with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11634_Richmo.pdf
Certificate Number: 230312139 Renewal Effective: 04/01/2020 Anticipated Recert Review: 3/31/2023 Program Location: 1st and 2nd Floors, 444 St. Mark's Place, Staten Island, New York 10301 Service Type: Outpatient Service (822) PRU: 53235 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12139_Richmo.pdf
RISE Housing and Support Services, Inc. Provider Number: 50590 Ms Sybil Newell M.A, Executive Director Telephone - (518)-587-6193 Administrative Office: 127 Union Street, Saratoga Springs, NY 12866
September 21, 2021 Page 169 of 225 Certificate Number: 190611645 Amendment Effective: 01/01/2018 Anticipated Recert Review: 6/30/2019 Program Location: 994 Route 67, , Ballston Spa, New York 12020 Service Type: Supportive Living (819) PRU: 51069 Certified Capacity: 6
Program Name: Hedgerow House Apartment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11645_Transi.pdf
Certificate Number: 200112180 Amendment Effective: 02/19/2019 Anticipated Recert Review: 1/31/2020 Program Location: 994 Route 67, , Ballston Spa, New York 12020 Service Type: Residential Services (820) PRU: 53320 Certified Capacity: 16
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Hedgerow House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12180_RISEHo.pdf
RiseBoro Community Partnership Provider Number: 23470 Mr. Scott Short, Chief Executive Officer Telephone - (718)-821-0254 Administrative Office: 555 Bushwick Avenue, Brooklyn, NY 11206
Certificate Number: 240411984 Renewal Effective: 05/01/2021 Anticipated Recert Review: 4/30/2024 Program Location: 5th Floor, 1474 Gates Avenue, Brooklyn, New York 11237 Service Type: Prevention Counseling PRU: 90769 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11984_RiseBo.pdf
The Riverdale Mental Health Association, Inc. Provider Number: 18040 Donna Demetri-Friedman Ph.D., Executive Director Telephone - (718)-796-5300 Ext 145 Administrative Office: 5676 Riverdale Avenue, Bronx, NY 10471
Certificate Number: 200911355 Amendment OMH Host Effective: 09/04/2020 Anticipated Recert Review: 9/30/2020 Program Location: Rooms #201 & #202, 2nd Floor, 5676 Riverdale Avenue, Bronx, New York 10471 Service Type: Outpatient Service (822) PRU: 2016 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11355_Riverd.pdf
Riverhead Community Awareness Program, Inc. Provider Number: 2011 Ms. Felicia Scocozza, Executive Director Telephone - (631)-727-3722 Ext 102 Administrative Office: Suite 106, 518 East Main Street, Riverhead, NY 11901
September 21, 2021 Page 170 of 225 Certificate Number: 201212222 Establishment Effective: 01/21/2020 Anticipated Recert Review: 12/31/2020 Program Location: Administrative Offices, Suite 106, 518 East Main Street, , Riverhead, New York 11901 Service Type: Prevention Counseling PRU: 90638 Certified Capacity: with Telepractice Designation
Program Name: Riverhead CAP
Phillips Avenue Elementary School, 1st Floor, Room 35, 141 Phillips Avenue, Riverhead, NY 11901 Other Service Site(s) At: Riverhead Middle School, 2nd Floor, Room N-30, 600 Harrison Avenue, Riverhead, NY 11901 Other Service Site(s) At: Roanoke Elementary School, 2nd Floor, Room 208, 549 Roanoke Avenue, Riverhead, NY 11901 Other Service Site(s) At: Riverhead High School, 2nd Floor, Room 205C, 700 Harrison Avenue, Riverhead, NY 11901 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12222_Riverh.pdf
The Rochester General Hospital Provider Number: 85320 Ms. Jill Graziano, Vice President of Behavioral Health Telephone - (585)-368-6931 Administrative Office: 1425 Portland Avenue, Rochester, NY 14621
Certificate Number: 191111337 Special ReIssue Deemed Effective: 01/01/2018 Anticipated Recert Review: 11/30/2019 Program Location: Hart Building, Rooms 70-72, 81-86 & E-7 (Offices), 1st Floor, 490 East Ridge Road, Rooms 19, 22A & B, 78, 80 (Group Space), Rochester, New York 14621 Service Type: Outpatient Service (822) PRU: 50216 Certified Capacity: with Telepractice Designation
Program Name: Rochester Mental Health Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11337_Roches.pdf
Rochester Regional Health as Active Parent and Co-Operator of Canton-Potsdam Hospital Provider Number: 83110 Mr. David B. Acker, President - CEO Telephone - (315)-261-6003 Administrative Office: 50 Leroy Street, Potsdam, NY 13676
Certificate Number: 211210698 Establishment Effective: 01/01/2021 Anticipated Recert Review: 12/31/2021 Program Location: 12 Elm Street, , Potsdam, New York 13676 Service Type: Outpatient Service (822) PRU: 51737 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10698_Roches.pdf
Certificate Number: 211211365 Establishment Effective: 01/01/2021 Anticipated Recert Review: 12/31/2021 Program Location: 20 Cottage Street, , Potsdam, New York 13676 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51183 Certified Capacity: 17
Program Name: Chemical Dependency Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11365_Roches.pdf
September 21, 2021 Page 171 of 225 Rochester Regional Health as Active Parent and Co-Operator of Gouverneur Hospital Provider Number: 50540 Mr. Eric R. Burch, CEO Telephone - 315-261-6006 Administrative Office: 77 West Barney Street, Gouverneur, NY 13642
Certificate Number: 211212186 Amendment Effective: 06/04/2021 Anticipated Recert Review: 12/31/2021 Program Location: 1500 Wing 1st Fl. 2300 Wi, 77 West Barney Street, , Gouverneur, New York 13642 Service Type: Outpatient Service (822) PRU: 53281 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12186_Roches.pdf
Rockville Centre Drug and Alcohol Abuse - CONFIDE, Inc. Provider Number: 78 Ms Valarie Garcia, Executive Director Telephone - (516)-764-5522 Administrative Office: Suite H-6, 30 Hempstead Avenue, Rockville Centre, NY 11570
Certificate Number: 230311534 Amendment Effective: 09/21/2020 Anticipated Recert Review: 3/31/2023 Program Location: Suites H-6, H-9 & H-12, Basement, 30 Hempstead Avenue, Rockville Centre, New York 11570 Service Type: Outpatient Service (822) PRU: 498 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11534_Rockvi.pdf
Rome Memorial Hospital, Inc. Provider Number: 81810 Mark Murphy M.D., President/Chief Executive Officer Telephone - (315)-338-7021 Administrative Office: 1500 North James Street, Rome, NY 13440
Certificate Number: 221210962 Amendment Effective: 05/13/2020 Anticipated Recert Review: 12/31/2022 Program Location: Liberty Plaza, 264 West Dominick Street, Rome, New York 13440 Service Type: Outpatient Service (822) PRU: 51124 Certified Capacity: with Telepractice Designation
Program Name: Community Recovery Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10962_RomeMe.pdf
Ruth M. Meyer d/b/a Community Counseling Services of Ronkonkoma Provider Number: 12000 Ms. Ruth M. Meyer, Executive Director Telephone - (631)-471-3122 Administrative Office: Administrative Site, Suite E-14, 3281 Veterans Memorial Highway, Ronkonkoma, NY 11779
Certificate Number: 201211107 Amendment Effective: 09/04/2020 Anticipated Recert Review: 12/31/2020 Program Location: E14, 3281 Veterans Memorial Highway, Ronkonkoma, New York 11779 Service Type: Outpatient Service (822) PRU: 51223 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11107_RuthMM.pdf
September 21, 2021 Page 172 of 225 S.A.F.E. Foundation, Inc. Provider Number: 45700 Mr. Ike Dweck, Chief Executive Officer Telephone - (866)-569-7233 Administrative Office: 255 Avenue W, Brooklyn, NY 11223
Certificate Number: 230211635 Amendment Effective: 08/25/2020 Anticipated Recert Review: 2/28/2023 Program Location: 255 Avenue W, Brooklyn, New York 11223 Service Type: Outpatient Service (822) PRU: 52129 Certified Capacity: with Telepractice and Problem Gambling Designations
Program Name: SAFE Foundation
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11635_SAFEFo.pdf
Safe Harbor Retreat, LLC d/b/a The Dunes - East Hampton Provider Number: 47650 Mr. Joseph McKinsey, Chief Executive Officer Telephone - (631)-604-5405 Administrative Office: 201 Fort Pond Boulevard, East Hampton, NY 11937
Certificate Number: 190711743 Amendment Effective: 03/01/2021 Anticipated Recert Review: 7/31/2019 Program Location: 15 Lohan Court, , Southampton, New York 11968 Service Type: Community Residential (819) PRU: 52571 Certified Capacity: 16 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11743_SafeHa.pdf
Certificate Number: 220911815 Amendment Effective: 10/28/2020 Anticipated Recert Review: 9/30/2022 Program Location: 201 Fort Pond Boulevard, East Hampton, New York 11937 Service Type: Outpatient Service (822) PRU: 52720 Certified Capacity: with Telepractice Designation
Program Name: The Dunes
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11815_SafeHa.pdf
Saint Regis Mohawk Tribe/ Saint Regis Mohawk Health Services Provider Number: 22290 Mr. Michael Cook, Executive Director Telephone - (518)-358-3141 Administrative Office: Health and Human Services Division, 404 State Route 37, Akwesasne, NY 13655
Certificate Number: 201010963 Amendment Effective: 08/21/2020 Anticipated Recert Review: 10/31/2020 Program Location: 404 State Route 37, , Akwasasne, New York 13655 Service Type: Outpatient Service (822) PRU: 5266 Certified Capacity: with Telepractice Designation
Program Name: Alcohol/Chemical Dependency Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10963_SaintR.pdf
September 21, 2021 Page 173 of 225 Certificate Number: 210211393 Renewal Effective: 03/01/2018 Anticipated Recert Review: 2/28/2021 Program Location: Partridge House, 25 St. Regis Road, Hogansburg, New York 13655 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50779 Certified Capacity: 16
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11393_SaintR.pdf
The Salvation Army Provider Number: 37020 Major John Haggerty, Chief Executive Director Telephone - (607)-732-0314 Administrative Office: Elmira Citadel, 414 Lake Street, Elmira, NY 14901
Certificate Number: 181210156 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Basement, 1st & 2nd Flrs., 401-403 Division Street, Elmira, New York 14901 Service Type: Community Residential (819) PRU: 50470 Certified Capacity: 25
Program Name: Elmira Citadel
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10156_Salvat.pdf
Samaritan Daytop Village, Inc. Provider Number: 16890 Mr. Mitchell Netburn, President and Chief Executive Telephone - (718)-206-2000 Ext 1200 Administrative Office: Officer Administrative Headquarters, 13802 Queens Boulevard, Jamaica, NY 11435
Certificate Number: 181210038 Conditional Certificate Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 1381 Dr. Martin Luther King Jr Blvd, Bronx, New York 10452 Service Type: Intensive Residential Rehabilitation (819) PRU: 3162 Certified Capacity: 60
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10038_Samari.pdf
Certificate Number: 181210040 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: (Residence), 327 West 43rd Street, 8th Floor, (Counseling), 321 West 44th Street, New York, New York 10036 Service Type: Intensive Residential Rehabilitation (819) PRU: 6974 Certified Capacity: 48
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10040_Samari.pdf
Certificate Number: 181210042 Conditional Certificate Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 88-83 Van Wyck Expressway, Jamaica, New York 11435 Service Type: Intensive Residential Rehabilitation (819) PRU: 7388 Certified Capacity: 30
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10042_Samari.pdf
September 21, 2021 Page 174 of 225 Certificate Number: 200510352 Amendment Effective: 04/29/2019 Anticipated Recert Review: 5/31/2020 Program Location: 130-20 89th Road, Richmond Hill, New York 11418 Service Type: Opioid Treatment Program (822) PRU: 52532 Certified Capacity: 12 [with ancillary withdrawal services] Capacity Lifted Program Name: Service Type: Residential Opioid Treatment Program (822) PRU: 393 Certified Capacity: 104
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10352_Samari.pdf
Certificate Number: 210811278 Amendment OASAS Host Effective: 08/23/2021 Anticipated Recert Review: 8/31/2021 Program Location: 144-10 Jamaica Avenue, , Jamaica, New York 11435 Service Type: Outpatient Service (822) PRU: 6595 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name: Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Service Type: Outpatient Rehabilitation Service (822) PRU: 53550 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11278_Samari.pdf
Certificate Number: 181211594 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 130-15 89th Road, Richmond Hill, New York 11418 Service Type: Intensive Residential Rehabilitation (819) PRU: 52067 Certified Capacity: 50
Program Name: Richmond Hill Veterans Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11594_Samari.pdf
Certificate Number: 181211750 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Floors 1 - 3, 751 Briggs Highway, Ellenville, New York 12428 Service Type: Intensive Residential Rehabilitation (819) PRU: 52579 Certified Capacity: 25
Program Name: Women Veterans Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11750_Samari.pdf
Certificate Number: 181211827 Conditional Certificate Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Basement, 1st-4th Floors, 68 West 106th Street, New York, New York 10025 Service Type: Community Residential (819) PRU: 52722 Certified Capacity: 36
Program Name:
September 21, 2021 Page 175 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11827_Samari.pdf
Certificate Number: 181211828 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 119 West 106th Street, New York, New York 10025 Service Type: Intensive Residential Rehabilitation (819) PRU: 52723 Certified Capacity: 36 and up to 30 beds for children Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11828_Samari.pdf
Certificate Number: 220311829 Amendment OASAS Host Effective: 08/05/2019 Anticipated Recert Review: 3/31/2022 Program Location: 7th Floor, 2090 Adam Clayton Powell, Jr. Blvd., , New York, New York 10027 Service Type: Outpatient Service (822) PRU: 52724 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name: Samaritan Daytop Village/Harlem Outpatient Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11829_Samari.pdf
Certificate Number: 220611915 Amendment Effective: 04/16/2021 Anticipated Recert Review: 6/30/2022 Program Location: 1st Floor, 250 Grand Concourse, , Bronx, New York 10451 Service Type: Opioid Treatment Program (822) PRU: 52883 Certified Capacity: 770 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11915_Samari.pdf
Certificate Number: 220611916 Amendment Effective: 08/23/2021 Anticipated Recert Review: 6/30/2022 Program Location: 1st & 2nd Floors, 362 East 148th Street, , Bronx, New York 10455 Service Type: Opioid Treatment Program (822) PRU: 52882 Certified Capacity: 850 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11916_Samari.pdf
Certificate Number: 210811937 Amendment OASAS Host Effective: 08/23/2021 Anticipated Recert Review: 8/31/2021 Program Location: 5th Floor, 362 East 148th Street, , Bronx, New York 10455 Service Type: Outpatient Service (822) PRU: 52897 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11937_Samari.pdf
September 21, 2021 Page 176 of 225 Certificate Number: 220211943 Conditional Certificate OASAS Host Effective: 11/25/2019 Anticipated Recert Review: 2/28/2022 Program Location: 338 Forbell Street, , Brooklyn, New York 11208 Service Type: Outpatient Service (822) PRU: 52916 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity: 0
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11943_Samari.pdf
Certificate Number: 220411956 Renewal OASAS Host Effective: 05/01/2019 Anticipated Recert Review: 4/1/2022 Program Location: 1st & 2nd Floors, 620 Route 303, Blauvelt, New York 10913 Service Type: Outpatient Service (822) PRU: 52930 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name: Rockland Outreach Center Service Type: Outpatient Rehabilitation Service (822) PRU: 53103 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Rockland Outreach Center Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11956_Samari.pdf
Certificate Number: 220311957 Renewal OASAS Host Effective: 04/01/2019 Anticipated Recert Review: 3/31/2022 Program Location: 900 Arnow Avenue, Bronx, New York 10469 Service Type: Outpatient Service (822) PRU: 52769 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name: Bronx Outreach Center Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11957_Samari.pdf
Certificate Number: 231111958 Renewal OASAS Host Effective: 11/01/2020 Anticipated Recert Review: 10/31/2023 Program Location: 2075 New York Avenue, Huntington Station, New York 11746 Service Type: Outpatient Service (822) PRU: 52931 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name: Suffolk Outreach Center Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
September 21, 2021 Page 177 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11958_Samari.pdf
Certificate Number: 220211960 Renewal OASAS Host Effective: 03/01/2019 Anticipated Recert Review: 2/28/2022 Program Location: Basement & 1st Floor, 1915 Forest Avenue, Staten Island, New York 10303 Service Type: Outpatient Service (822) PRU: 52771 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name: Staten Island Outreach Center Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11960_Samari.pdf
Certificate Number: 181212119 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 88-83 Van Wyck Expressway, Jamaica, New York 11435 Service Type: Residential Services (820) PRU: 53119 Certified Capacity: 80
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12119_Samari.pdf
Certificate Number: 240212120 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/28/2023 Program Location: 767 Cape Road, Ellenville, New York 12428 Service Type: Residential Services (820) PRU: 53118 Certified Capacity: 80
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12120_Samari.pdf
Certificate Number: 210312226 Establishment Effective: 04/13/2020 Anticipated Recert Review: 3/31/2021 Program Location: 751 Briggs Highway, , Ellenville, New York 12428 Service Type: Residential Services (820) PRU: 53460 Certified Capacity: 135 [Men's Dorm - 105 beds, Women's Dorm - 30 beds]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12226_Samari.pdf
Certificate Number: 211012238 Amendment Effective: 03/15/2021 Anticipated Recert Review: 10/31/2021 Program Location: Buildings #4, 10, 11, 15 , 88 Fox Hollow Road, , Rhinebeck, New York 12572 Service Type: Residential Services (820) PRU: 53512 Certified Capacity: 56
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12238_Samari.pdf
September 21, 2021 Page 178 of 225 Certificate Number: 211012239 Establishment Effective: 11/02/2020 Anticipated Recert Review: 10/31/2021 Program Location: 190 Fox Hollow Road, , Rhinebeck, New York 12572 Service Type: Residential Services (820) PRU: 53513 Certified Capacity: 92
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Fox Run Male Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Samaritan Medical Center Provider Number: 15920 Mr. Thomas Carman, Chief Executive Officer Telephone - (315)-785-4000 Administrative Office: 830 Washington Street, Watertown, NY 13601
Certificate Number: 220310969 Amendment Effective: 07/01/2020 Anticipated Recert Review: 3/31/2022 Program Location: 1st Floor, 1575 Washington Street, Watertown, New York 13601 Service Type: Outpatient Service (822) PRU: 51705 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Samaritan Medical Center Addiction Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10969_Samari.pdf
Saratoga County Community Services Board Provider Number: 70840 Michael S. Prezioso Ph.D., CommissionerServices Telephone - (518)-584-9030 Ext 1020 Administrative Office: 135 South Broadway, Saratoga Springs, NY 12866
Certificate Number: 201010971 Conditional Certificate Effective: 07/10/2020 Anticipated Recert Review: 10/31/2020 Program Location: 135 South Broadway, , Saratoga Springs, New York 12866 Service Type: Outpatient Service (822) PRU: 50759 Certified Capacity: with Telepractice Designation
Program Name: Saratoga County Alcohol & Substance Abuse Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10971_Sarato.pdf
The Saratoga Hospital Provider Number: 87070 Mr. Angelo G. Calbone, President/CEO Telephone - (518)-587-3222 Administrative Office: 1st Floor, 211 Church Street, Saratoga Springs, NY 12866
Certificate Number: 220712152 Amendment Effective: 09/21/2020 Anticipated Recert Review: 7/31/2022 Program Location: 1st Floor, 24 Hamilton Street, Saratoga Springs, New York 12866 Service Type: Outpatient Service (822) PRU: 53269 Certified Capacity: with Telepractice Designation
Program Name: Saratoga Community Health Center's Addiction Medicine Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12152_Sarato.pdf
SCAN-New York Volunteer Parent-Aides Association, Inc. Provider Number: 2035 Mr. Lewis Zuchman, Executive Director Telephone - (212)-289-8030 Administrative Office: Suite 301, 345 East 102nd Street, New York, NY 10029
September 21, 2021 Page 179 of 225 Certificate Number: 210211338 Renewal Effective: 03/01/2018 Anticipated Recert Review: 2/28/2021 Program Location: Basement & 1st Floor, 1377 Jerome Avenue, Bronx, New York 10452 Service Type: Outpatient Service (822) PRU: 7422 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11338_SCANNe.pdf
Schenectady Family Health Services, Inc. d/b/a Hometown Health Centers Provider Number: 51390 Mr. Joseph Gambino, Chief Executive Officer Telephone - (518)-370-1441 Ext 4126 Administrative Office: 1044 State Street, Schenectady, NY 12307
Certificate Number: 211212252 Establishment Effective: 01/04/2021 Anticipated Recert Review: 12/31/2021 Program Location: 1044 State Street, , Schenectady, New York 12307 Service Type: Outpatient Service (822) PRU: 53493 Certified Capacity: with Telepractice Designation
Program Name: Hometown Health Centers
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12252_Schene.pdf
Schoharie County Community Services Board Provider Number: 70740 Ms. Bonnie L. Post, Director of Community Services Telephone - (518)-295-8407 Administrative Office: County Annex Building, Suite #1, 113 Park Place, PO Box 160, Schoharie, NY 12157
Certificate Number: 201210972 Amendment Effective: 09/04/2020 Anticipated Recert Review: 12/31/2020 Program Location: Schoharie County Annex Building, Suite #1, 113 Park Place, Schoharie, New York 12157 Service Type: Outpatient Service (822) PRU: 50427 Certified Capacity: with Telepractice and Problem Gambling Designations
Program Name: Schoharie County Chemical Dependencies Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10972_Schoha.pdf
SCO Family of Services Provider Number: 22270 Mr. Keith Little, Executive Director Telephone - (516)-671-1253 Administrative Office: 1 Alexander Place, Glen Cove, NY 11542
Certificate Number: 240312177 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: 2nd Floor, 151 Burrs Lane, , Dix Hills, New York 11746 Service Type: Residential Services (820) PRU: 53316 Certified Capacity: 20
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Morning Star I
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
September 21, 2021 Page 180 of 225 Certificate Number: 240312178 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: Freestanding Building - 1st Floor, Main Building - 2nd Floor, Morning Star II Expansion, 151 Burrs Lane, , Dix Hills, New York 11746 Service Type: Residential Services (820) PRU: 53317 Certified Capacity: 23 and up to 25 beds for children Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Morning Star II
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12178_SCOFam.pdf
Certificate Number: 220712272 Establishment Effective: 08/23/2021 Anticipated Recert Review: 7/31/2022 Program Location: 151 Burrs Lane, , Dix Hills, New York 11746 Service Type: Outpatient Service (822) PRU: 53029 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12272_SCOFam.pdf
Seafield Center, Inc. Provider Number: 18990 Mr. Mark Epley, CEO Telephone - (631)-288-1122 Ext 204 Administrative Office: 7 Seafield Lane, Westhampton Beach, NY 11978
Certificate Number: 220411395 Conditional Certificate Effective: 03/01/2021 Anticipated Recert Review: 4/30/2022 Program Location: 1st and 2nd Floors, 7 Seafield Lane, Westhampton Beach, New York 11978 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50893 Certified Capacity: 100 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11395_Seafie.pdf
Seafield Services, Inc. Provider Number: 17440 Mr. Mark Epley, Chief Executive Officer Telephone - (631)-288-1122 Administrative Office: 7 Seafield Lane, Westhampton Beach, NY 11978
Certificate Number: 201110581 Amendment Effective: 07/01/2020 Anticipated Recert Review: 11/30/2020 Program Location: 212 and 230 West Main Street, Riverhead, New York 11901 Service Type: Outpatient Service (822) PRU: 5830 Certified Capacity: with Telepractice Designation
Program Name: Seafield Riverhead
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10581_Seafie.pdf
September 21, 2021 Page 181 of 225 Certificate Number: 221110582 Amendment Effective: 07/01/2020 Anticipated Recert Review: 11/30/2022 Program Location: 1st & 2nd Floors, 37 John Street, Amityville, New York 11701 Service Type: Outpatient Service (822) PRU: 50895 Certified Capacity: with Telepractice Designation
Program Name: Seafield Amityville Service Type: Outpatient Rehabilitation Service (822) PRU: 52961 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10582_Seafie.pdf
Certificate Number: 210910583 Amendment Effective: 07/01/2020 Anticipated Recert Review: 9/30/2021 Program Location: Basement, 1st and 2nd Floors, 110 Main Street, Mineola, New York 11501 Service Type: Outpatient Service (822) PRU: 51109 Certified Capacity: with Telepractice Designation
Program Name: Seafield Mineola
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10583_Seafie.pdf
Certificate Number: 231110977 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: Suite 101, 1st Floor, 475 East Main Street, East Patchogue, New York 11772 Service Type: Outpatient Service (822) PRU: 7246 Certified Capacity: with Telepractice Designation
Program Name: Seafield Patchogue
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10977_Seafie.pdf
Certificate Number: 231010978 Renewal Effective: 11/01/2020 Anticipated Recert Review: 10/31/2023 Program Location: Bldg. 9, 3251 Route 112, Medford, New York 11763 Service Type: Outpatient Service (822) PRU: 51806 Certified Capacity: with Telepractice Designation
Program Name: Seafield Medford
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10978_Seafie.pdf
Seneca County Community Services Board Provider Number: 70330 Ms. Margaret Morse, Director of Community Services Telephone - (315)-539-1985 Administrative Office: 31 Thurber Drive, Waterloo, NY 13165
Certificate Number: 231010984 Renewal OMH Host Effective: 11/01/2020 Anticipated Recert Review: 10/31/2023 Program Location: 31 Thurber Drive, Waterloo, New York 13165 Service Type: Outpatient Service (822) PRU: 50431 Certified Capacity: 0 with Problem Gambling Designation [with ancillary withdrawal services] with Telepractice Designation
Program Name:
September 21, 2021 Page 182 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10984_Seneca.pdf
Certificate Number: 210411986 Amendment Effective: 10/28/2020 Anticipated Recert Review: 4/30/2021 Program Location: 31 Thurber Drive, Waterloo, New York 13165 Service Type: Prevention Counseling PRU: 90731 Certified Capacity: with Telepractice Designation
Program Name:
La Fayette Elementary School, 2nd Floor, Room Adjacent to Room 211, 71 Inslee Street, Waterloo, NY 13165 Other Service Site(s) At: Mynderse Academy High School, 1st Floor, Room 150A, 105 Troy Street, Seneca Falls, NY 13148 Other Service Site(s) At: Waterloo High School, 96 Stark Street, Waterloo, NY 13165 Other Service Site(s) At: Frank Knight Elementary School, 1st Floor, Room 42, 98 Clinton Street, Seneca Falls, NY 13148 Other Service Site(s) At: South Seneca Middle/High School, 2nd Floor, North, Rooms W & M, 7263 Main Street, Ovid, NY 14521 Other Service Site(s) At: Waterloo Middle School, 65 Center Street, Waterloo, NY 13165 Other Service Site(s) At: Seneca Falls Middle School, 1st Floor, Conference Room, 95 Troy Street, Seneca Falls, NY 13148 Other Service Site(s) At: Romulus Central School, 1st Floor, Room 40, 5705 Main Street, Romulus, NY 14541 Other Service Site(s) At: Cady Stanton Elementary School, 1st Floor, Room 13, 38 Garden Street, Seneca Falls, NY 13148 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11986_Seneca.pdf
Senior Hope Counseling, Inc. Provider Number: 45240 Nicole MacFarland Ph.D., Executive Director Telephone - (518)-489-7777 Ext 102 Administrative Office: 2nd Floor, 650 Warren Street, Albany, NY 12208
Certificate Number: 221111589 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2022 Program Location: 2nd Floor, 650 Warren Street, , Albany, New York 12208 Service Type: Outpatient Service (822) PRU: 52134 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11589_Senior.pdf
Services for the Underserved, Inc. as Sponsor Palladia, Inc. as Operator Provider Number: 39050 Ms. Donna Colonna, President and Chief Executive Telephone - (212)-633-6900 Administrative Office: Officer Palladia, Inc. as Operator, 17th Floor, 463 7th Avenue, New York, NY 10018
September 21, 2021 Page 183 of 225 Certificate Number: 211011885 Renewal OASAS Host Effective: 11/01/2019 Anticipated Recert Review: 10/31/2021 Program Location: 2nd Floor, 177-185 East 122nd Street, New York, New York 10035 Service Type: Outpatient Service (822) PRU: 52857 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: CTI Harlem Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
1366 Inwood Avenue, Bronx, NY 10452 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11885_Servic.pdf
Certificate Number: 190511887 Amendment Effective: 01/04/2018 Anticipated Recert Review: 5/31/2019 Program Location: Basement-5th Floors, 1806-08 Third Avenue, New York, New York 10029 Service Type: Community Residential (819) PRU: 52856 Certified Capacity: 72
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11887_Servic.pdf
SES Operating Corp. d/b/a Harlem East Life Plan Provider Number: 550 Mr. Stuart R. Steiner, President, Executive Director Telephone - (212)-876-2300 Ext 102 Administrative Office: 2369 Second Avenue, New York, NY 10035
Certificate Number: 221010384 Amendment Effective: 07/03/2020 Anticipated Recert Review: 10/31/2022 Program Location: 1st & 2nd Floors, 2369 Second Avenue, , New York, New York 10035 Service Type: Opioid Treatment Program (822) PRU: 1474 Certified Capacity: 500 with Telepractice Designation [with ancillary withdrawal services for up to 50 patients] Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10384_SESOpe.pdf
Certificate Number: 221010385 Amendment Effective: 07/03/2020 Anticipated Recert Review: 10/31/2022 Program Location: 1st & 2nd Floors, 2369 Second Avenue, , New York, New York 10035 Service Type: Opioid Treatment Program (822) PRU: 7340 Certified Capacity: 50 with Telepractice Designation - 50 of which are Key Extended Entry Program (KEEP) Patients [with ancillary withdrawal services for up to 50 patients]
Program Name: Service Type: Opioid Treatment Program (822) PRU: 1473 Certified Capacity: 500 with Telepractice Designation - 50 of which are Key Extended Entry Program (KEEP) Patients [with ancillary withdrawal services for up to 50 patients] Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10385_SESOpe.pdf
September 21, 2021 Page 184 of 225 Certificate Number: 211211292 Amendment Effective: 07/03/2020 Anticipated Recert Review: 12/31/2021 Program Location: 2369 Second Avenue, 3rd Floor, 2367 Second Avenue, 1st Floor, New York, New York 10035 Service Type: Outpatient Service (822) PRU: 51840 Certified Capacity: 0 with Telepractice Designation
Program Name: Harlem East Life Plan (HELP)
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11292_SESOpe.pdf
Shiloh Psychological Consulting PLLC Provider Number: 50550 Kay Jackson Ph.D., Executive Director/Owner Telephone - 212-564-7631 Administrative Office: 4th Floor, 566 Seventh Avenue, New York, NY 10018
Certificate Number: 200212160 Establishment Effective: 03/01/2019 Anticipated Recert Review: 2/29/2020 Program Location: 4th Floor, 566 Seventh Avenue, , New York, New York 10018 Service Type: Outpatient Service (822) PRU: 53293 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Silver Lake Support Services, Inc. Provider Number: 41860 Mr. Avraham Schick, Executive Director Telephone - (718)-815-3155 Administrative Office: 201 Forest Avenue, Staten Island, NY 10301
Certificate Number: 220710987 Amendment Effective: 08/22/2019 Anticipated Recert Review: 7/31/2022 Program Location: 1st & 2nd Floors, 201 Forest Avenue, , Staten Island, New York 10301 Service Type: Outpatient Service (822) PRU: 51829 Certified Capacity: 0 with Telepractice Designation
Program Name:
1st Floor, 797 Brighton Avenue, Staten Island, NY 10301 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10987_Silver.pdf
Sisters of Charity Hospital of Buffalo, New York Provider Number: 81820 Mr. Martin Boryszak, President & CEO Telephone - (716)-862-1903 Administrative Office: 2157 Main Street, Buffalo, NY 14214
Certificate Number: 210610408 Amendment Effective: 07/31/2020 Anticipated Recert Review: 6/30/2021 Program Location: 158 Holden Street, , Buffalo, New York 14214 Service Type: Opioid Treatment Program (822) PRU: 409 Certified Capacity: 650 with Telepractice Designation Capacity Lifted Program Name: Service Type: Opioid Medical Maintenance (822) PRU: 7347 Certified Capacity:
Program Name:
September 21, 2021 Page 185 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10408_Sister.pdf
Certificate Number: 210710409 Amendment Deemed Effective: 07/22/2020 Anticipated Recert Review: 7/20/2021 Program Location: 1st Floor, 435 East Henrietta Road, , Rochester, New York 14620 Service Type: Opioid Treatment Program (822) PRU: 6924 Certified Capacity: 250 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10409_Sister.pdf
Certificate Number: 220310988 Amendment Effective: 07/10/2020 Anticipated Recert Review: 3/31/2022 Program Location: 1st Floor, 210 John Glenn Drive, , Amherst, New York 14228 Service Type: Outpatient Service (822) PRU: 51018 Certified Capacity: with Telepractice Designation
Program Name: Sisters Health Center Amherst
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10988_Sister.pdf
Certificate Number: 210610992 Renewal Effective: 07/01/2018 Anticipated Recert Review: 6/30/2021 Program Location: 1500 Broadway, Buffalo, New York 14212 Service Type: Outpatient Service (822) PRU: 51564 Certified Capacity:
Program Name: STAR (Substance Treatment and Recovery) St. Vincent
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10992_Sister.pdf
Certificate Number: 210912158 Amendment Effective: 08/10/2021 Anticipated Recert Review: 9/30/2021 Program Location: 1st Floor, 210 John Glenn Drive, , Amherst, New York 14228 Service Type: Opioid Treatment Program (822) PRU: 53282 Certified Capacity: 250 with Telepractice Designation Capacity Lifted Program Name: Sisters Health Center Amherst
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12158_Sister.pdf
South Brooklyn Medical Administrative Services, Inc. Provider Number: 553 Ms. Alexis Bosco, Administrator & Chief Executive Telephone - (718)-788-2594 Ext 117 Administrative Office: Officer 685 Third Avenue, Brooklyn, NY 11232
Certificate Number: 221210387 Renewal Effective: 01/01/2020 Anticipated Recert Review: 12/31/2022 Program Location: 685 3rd Avenue, Brooklyn, New York 11232 Service Type: Opioid Treatment Program (822) PRU: 1479 Certified Capacity: 450
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10387_SouthB.pdf
September 21, 2021 Page 186 of 225 South Richmond Hill Recovery, LLC Provider Number: 49820 Mr. John J. Saith, Program Director Telephone - (718)-785-3380 Ext 101 Administrative Office: 88-08 Liberty Avenue, Ozone Park, NY 11417
Certificate Number: 230212114 Amendment Effective: 09/09/2020 Anticipated Recert Review: 2/28/2023 Program Location: 88-08 Liberty Avenue, , Ozone Park, New York 11417 Service Type: Outpatient Service (822) PRU: 53167 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12114_SouthR.pdf
Southeast Nassau Guidance Center, Inc. Provider Number: 50150 Milton Kalin Ph.D., Chief Executive Officer Telephone - (516)-679-9800 Administrative Office: 2146 Jackson Avenue, P.O. Box 1037, Seaford, NY 11783
Certificate Number: 240710994 Renewal Effective: 08/01/2021 Anticipated Recert Review: 7/31/2024 Program Location: 2nd Floor, 3375 Park Avenue, Wantagh, New York 11793 Service Type: Outpatient Service (822) PRU: 446 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10994_Southe.pdf
Certificate Number: 211110995 Amendment Effective: 06/22/2020 Anticipated Recert Review: 11/30/2021 Program Location: 1st & 2nd Floor, 2146 Jackson Avenue, , Seaford, New York 11783 Service Type: Outpatient Service (822) PRU: 50473 Certified Capacity: with Telepractice Designation
Program Name: Chemical Dependence Counseling and Treatment
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10995_Southe.pdf
Sports Foundation, Inc. Provider Number: 1613 Akinshey X. Dorsett, Executive Director Telephone - (718)-665-9585 Administrative Office: 871 Westchester Avenue, Bronx, NY 10459
Certificate Number: 200611975 Renewal Effective: 07/01/2018 Anticipated Recert Review: 6/30/2020 Program Location: Basement, 1st Floor Lobby, 871 Westchester Avenue, Bronx, New York 10459 Service Type: Prevention Counseling PRU: 90748 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11975_Sports.pdf
St. Barnabas Hospital Provider Number: 81630 David Perlstein M.D., President and Chief Executive Telephone - (718)-960-6561 Administrative Office: Officer Administration - Braker Building, 4421 Third Avenue, Bronx, NY 10457
September 21, 2021 Page 187 of 225 Certificate Number: 220610234 Amendment Effective: 10/19/2020 Anticipated Recert Review: 6/30/2022 Program Location: Main Building, 4th Floor, 4422 Third Avenue, Bronx, New York 10457 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 50717 Certified Capacity: 24 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10234_StBarn.pdf
Certificate Number: 231110406 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: 4535 Third Avenue, , Bronx, New York 10458 Service Type: Opioid Treatment Program (822) PRU: 6962 Certified Capacity: 660 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10406_StBarn.pdf
Certificate Number: 211010997 Amendment Effective: 07/03/2020 Anticipated Recert Review: 10/31/2021 Program Location: 2nd floor, 4441-4451 Third Avenue, Bronx, New York 10457 Service Type: Outpatient Service (822) PRU: 50718 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10997_StBarn.pdf
St. Charles Hospital, Port Jefferson, New York Provider Number: 82100 Mr. James O'Connor, Executive Vice President and Telephone - (631)-474-6105 Administrative Office: CEO 1st Floor, 200 Belle Terre Road, Port Jefferson, NY 11777
Certificate Number: 211111398 Renewal Deemed Effective: 01/09/2019 Anticipated Recert Review: 11/17/2021 Program Location: 5 North and 5 South, 5th Floor, 200 Belle Terre Road, , Port Jefferson, New York 11777 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51415 Certified Capacity: 40
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11398_StChar.pdf
Certificate Number: 211111839 Renewal Deemed Effective: 01/09/2019 Anticipated Recert Review: 11/17/2021 Program Location: 2 North, 2nd Floor, 200 Belle Terre Road, , Port Jeffferson, New York 11777 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 52754 Certified Capacity: 20 [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11839_StChar.pdf
September 21, 2021 Page 188 of 225 Certificate Number: 211111844 Renewal Deemed Effective: 01/09/2019 Anticipated Recert Review: 11/17/2021 Program Location: 3 West, 3rd Floor, 200 Belle Terre Road, Port Jefferson, New York 11777 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 52762 Certified Capacity: 4 (adolescent) [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11844_StChar.pdf
St. Christopher's Inn, Inc. Provider Number: 25360 James Schiller Ph.D., Executive Director Telephone - (845)-335-1009 Administrative Office: Box 150, 21 Franciscan Way, Garrison, NY 10524
Certificate Number: 201110564 Amendment Effective: 09/01/2020 Anticipated Recert Review: 11/30/2020 Program Location: 21 Franciscan Way, Garrison, New York 10524 Service Type: Outpatient Service (822) PRU: 51663 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51900 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10564_StChri.pdf
Certificate Number: 210311243 Renewal Effective: 04/01/2018 Anticipated Recert Review: 3/31/2021 Program Location: 21 Franciscan Way, Garrison, New York 10524 Service Type: Medically Supervised Outpatient Withdrawal & Stabilization (816.8) PRU: 8053 Certified Capacity: 10 [without the use of methadone]
Program Name: St. Christopher's Inn
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11243_StChri.pdf
Certificate Number: 231212183 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2023 Program Location: 13 Longview Avenue, , White Plains, New York 10605 Service Type: Residential Services (820) PRU: 53324 Certified Capacity: 11
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Brothers Christopher House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12183_StChri.pdf
St. John's Riverside Hospital, Inc. Provider Number: 87150 Mr. Ronald J. Corti, President and CEO Telephone - (914)-964-4221 Administrative Office: Andrus Pavilion, 967 North Broadway, Yonkers, NY 10701
September 21, 2021 Page 189 of 225 Certificate Number: 231211245 Amendment Effective: 03/07/2021 Anticipated Recert Review: 12/31/2023 Program Location: Wellness Center & Lab, 1st Floor, 2 Park Avenue, Yonkers, New York 10703 Service Type: Opioid Treatment Program (822) PRU: 401 Certified Capacity: 400 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11245_StJohn.pdf
Certificate Number: 220111247 Renewal Effective: 02/01/2019 Anticipated Recert Review: 1/31/2022 Program Location: North Wing, 3rd & 6th Floors North, 2 Park Avenue, Yonkers, New York 10703 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 50820 Certified Capacity: 72 - with the use of methadone
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11247_StJohn.pdf
Certificate Number: 210711281 Amendment Effective: 09/04/2020 Anticipated Recert Review: 7/31/2021 Program Location: 2nd Floor, 2 Park Avenue, Yonkers, New York 10703 Service Type: Outpatient Service (822) PRU: 51378 Certified Capacity: with Telepractice Designation
Program Name: New Focus Center Service Type: Outpatient Rehabilitation Service (822) PRU: 51945 Certified Capacity: with Telepractice Designation
Program Name: New Focus Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11281_StJohn.pdf
Certificate Number: 201111283 Amendment Effective: 09/04/2020 Anticipated Recert Review: 11/30/2020 Program Location: 1st Floor, 30 Manhattan Avenue, White Plains, New York 10607 Service Type: Outpatient Service (822) PRU: 51687 Certified Capacity: with Telepractice Designation
Program Name: Greenburgh ATS Service Type: Outpatient Rehabilitation Service (822) PRU: 51944 Certified Capacity: with Telepractice Designation
Program Name: Greenburgh ATS
Westhab-Coachman Family Center, 1-1/2 Main Mezzanine, 123 East Post Road, White Plains, NY 10601 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11283_StJohn.pdf
September 21, 2021 Page 190 of 225 Certificate Number: 240611284 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2024 Program Location: 1st Floor, 20 East First Street, Mount Vernon, New York 10550 Service Type: Outpatient Service (822) PRU: 50638 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51947 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11284_StJohn.pdf
Certificate Number: 220111401 Renewal Effective: 02/01/2019 Anticipated Recert Review: 1/31/2022 Program Location: 3rd Floor, West Wing, 5th Floor, North Wing, 3rd Floor, East Wing, 2 Park Avenue, Yonkers, New York 10703 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51609 Certified Capacity: 69
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11401_StJohn.pdf
St. Josephs Hospital, Yonkers Provider Number: 81050 Mr. Michael J. Spicer, President & CEO Telephone - (914)-378-7485 Administrative Office: 127 South Broadway, Yonkers, NY 10701
Certificate Number: 210310399 Renewal Deemed Effective: 04/01/2018 Anticipated Recert Review: 3/31/2021 Program Location: 1st Floor, 317 South Broadway, Yonkers, New York 10705 Service Type: Opioid Treatment Program (822) PRU: 400 Certified Capacity: 500
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10399_StJose.pdf
Certificate Number: 210710633 Amendment Deemed Effective: 09/25/2019 Anticipated Recert Review: 7/28/2021 Program Location: 2nd Floor, 317 South Broadway, Yonkers, New York 10705 Service Type: Outpatient Service (822) PRU: 50874 Certified Capacity: 0 with Telepractice Designation
Program Name: Positive Directions Service Type: Outpatient Rehabilitation Service (822) PRU: 51938 Certified Capacity: 0 with Telepractice Designation
Program Name: Positive Directions
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10633_StJose.pdf
Certificate Number: 200611733 Special ReIssue Deemed Effective: 01/01/2018 Anticipated Recert Review: 6/30/2020 Program Location: 3rd & 4th Floors, 175-20 Hillside Avenue, Jamaica, New York 11432 Service Type: Opioid Treatment Program (822) PRU: 52569 Certified Capacity: 800 Capacity Lifted Program Name: Queens Opioid Treatment Clinic
September 21, 2021 Page 191 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11733_StJose.pdf
Certificate Number: 220711736 Amendment Deemed Effective: 06/22/2020 Anticipated Recert Review: 7/31/2022 Program Location: 211-221 Powell Street, , Brooklyn, New York 11212 Service Type: Opioid Treatment Program (822) PRU: 52566 Certified Capacity: 450 Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11736_StJose.pdf
Certificate Number: 210711737 Amendment Deemed Effective: 09/25/2019 Anticipated Recert Review: 7/28/2021 Program Location: The Maxwell Institute Alcoholism Outpatient Clinic Program, 1st Floor, 92 Yonkers Avenue, Tuckahoe, New York 10707 Service Type: Outpatient Service (822) PRU: 52563 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11737_StJose.pdf
Certificate Number: 200511738 Special ReIssue Deemed Effective: 01/01/2018 Anticipated Recert Review: 5/31/2020 Program Location: 1st and 2nd Floor, 480 Alabama Avenue, Brooklyn, New York 11207 Service Type: Opioid Treatment Program (822) PRU: 52570 Certified Capacity: 700 Capacity Lifted Program Name: Alabama Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11738_StJose.pdf
Certificate Number: 210711741 Amendment Deemed Effective: 09/25/2019 Anticipated Recert Review: 7/28/2021 Program Location: Spellman Building, Ground Floor & 1st Floor, 275 North Street, , Harrison, New York 10528 Service Type: Outpatient Service (822) PRU: 52564 Certified Capacity: 0 with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 52565 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11741_StJose.pdf
Certificate Number: 210711742 Renewal Deemed Effective: 09/19/2018 Anticipated Recert Review: 7/28/2021 Program Location: Spellman Building, 1st Floor, 275 North Street, , Harrison, New York 10528 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 52559 Certified Capacity: 30
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11742_StJose.pdf
September 21, 2021 Page 192 of 225 Certificate Number: 210311835 Amendment Effective: 06/07/2019 Anticipated Recert Review: 3/31/2021 Program Location: 1st Floor, 132 Pearl Street, Port Chester, New York 10573 Service Type: Outpatient Service (822) PRU: 52746 Certified Capacity: 0 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11835_StJose.pdf
Certificate Number: 240112134 Renewal Effective: 02/01/2021 Anticipated Recert Review: 1/31/2024 Program Location: 18 Spring Street, Port Chester, New York 10573 Service Type: Residential Services (820) PRU: 53228 Certified Capacity: 20
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Sr. Anne Mary Regan Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12134_StJose.pdf
St. Joseph's Rehabilitation Center, Inc. Provider Number: 35160 Mr. Robert Ross, Chief Executive Officer/President Telephone - (518)-891-3310 Ext 242 Administrative Office: 159 Glenwood Drive, Saranac Lake, NY 12983 d/b/a St. Joseph's Addiction Treatment and Recovery Centers Certificate Number: 210610130 Amendment Effective: 10/16/2019 Anticipated Recert Review: 6/30/2021 Program Location: Building #1, and Family Building, 1st, 2nd & 3rd Floors,, 159 Glenwood Drive, Saranac Lake, New York 12983 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50169 Certified Capacity: 67 with Telepractice Designation
Program Name: Chemical Dependence Rehabilitation
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10130_StJose.pdf d/b/a St. Joseph's Addiction Treatment and Recovery Centers Certificate Number: 181210131 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 7 Fallkill Place, Poughkeepsie, New York 12601 Service Type: Supportive Living (819) PRU: 51646 Certified Capacity: 12
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10131_StJose.pdf d/b/a St. Joseph's Addiction Treatment and Recovery Centers Certificate Number: 231011003 Amendment Effective: 08/04/2021 Anticipated Recert Review: 10/31/2023 Program Location: Suite 103, 258 Broadway, Saranac Lake, New York 12983 Service Type: Outpatient Service (822) PRU: 50171 Certified Capacity: 0 with Telepractice and Problem Gambling Designations
Program Name:
386 River Road, Lake Placid, NY 12946 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11003_StJose.pdf
September 21, 2021 Page 193 of 225 d/b/a St. Joseph's Addiction Treatment and Recovery Centers Certificate Number: 211011004 Amendment Effective: 10/21/2020 Anticipated Recert Review: 10/31/2021 Program Location: 458 East Main Street, Malone, New York 12953 Service Type: Outpatient Service (822) PRU: 50170 Certified Capacity: 0 with Telepractice and Problem Gambling Designations
Program Name:
Bushnell Medical Building, 17 Hospital Drive, Massena, NY 13662 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11004_StJose.pdf d/b/a St. Joseph's Addiction Treatment and Recovery Centers Certificate Number: 210111005 Amendment Effective: 04/16/2020 Anticipated Recert Review: 1/31/2021 Program Location: 1st & 2nd Floors, 50 Montcalm Street, Ticonderoga, New York 12883 Service Type: Outpatient Service (822) PRU: 50173 Certified Capacity: 0 with Telepractice and Problem Gambling Designations
Program Name: Ticonderoga Chemical Dependence Outpatient Clinic
7520 Court Street, Elizabethtown, NY 12932 Additional Location(s) At: 1st Floor, 1703 Front Street, Keeseville, NY 12944 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11005_StJose.pdf d/b/a St. Joseph's Addiction Treatment and Recovery Centers Certificate Number: 240512052 Renewal Effective: 06/01/2021 Anticipated Recert Review: 5/31/2024 Program Location: Floors 1-2, 444 Kiwassa Lake Road, Saranac Lake, New York 12983 Service Type: Residential Services (820) PRU: 53046 Certified Capacity: 25 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: Col. C. David Merkel, MD Veterans Residential Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12052_StJose.pdf d/b/a Rose Hill Certificate Number: 240212067 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/29/2024 Program Location: 100 County Route 43, Massena, New York 13662 Service Type: Residential Rehabilitation Services for Youth (817) PRU: 53062 Certified Capacity: -- Rose Hill Young Adult Program 14 Beds -- Rose Hill Adolescent Program 14 Beds with Telepractice Designation
Program Name: Rose Hill Service Type: Residential Rehabilitation Services for Youth (817) PRU: 53063 Certified Capacity: 28 -- Rose Hill Young Adult Program 14 Beds -- Rose Hill Adolescent Program 14 Beds with Telepractice Designation
Program Name: Rose Hill
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12067_StJose.pdf
September 21, 2021 Page 194 of 225 St. Lawrence County Community Services Board Provider Number: 70700 Mr. Jay Ulrich, Director of Community Services Telephone - (315)-379-2276 Administrative Office: Canton Human Services Center, Suite #1, 80 State Highway 310, Canton, NY 13617
Certificate Number: 221211007 Amendment Effective: 04/30/2021 Anticipated Recert Review: 12/31/2022 Program Location: 2nd Floor, 80 State Highway 310, , Canton, New York 13617 Service Type: Outpatient Service (822) PRU: 50188 Certified Capacity: 0 with Telepractice Designation
Program Name: St. Lawrence County Addictions Services Canton
99 West Main Street, Gouverneur, NY 13642 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11007_StLawr.pdf
Certificate Number: 230911009 Amendment Effective: 04/30/2021 Anticipated Recert Review: 9/30/2023 Program Location: 2nd Floor, 206 Ford Street, , Ogdensburg, New York 13699 Service Type: Outpatient Service (822) PRU: 51417 Certified Capacity: 0 with Telepractice Designation
Program Name: St. Lawrence County Addiction Services Ogdensburg
1st Floor, 21 Harrowgate Commons, Massena, NY 13662 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11009_StLawr.pdf
St. Mark's Place Institute For Mental Health, Inc. Provider Number: 15480 Roman Pabis Ph.D., Executive Director Telephone - (212)-982-3470 Ext 124 Administrative Office: 57 St. Mark's Place, New York, NY 10003
Certificate Number: 210611011 Amendment OMH Host Effective: 08/03/2020 Anticipated Recert Review: 6/30/2021 Program Location: 1st, 2nd and 3rd Floors, 57 St. Mark's Place, New York, New York 10003 Service Type: Outpatient Service (822) PRU: 51582 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11011_StMark.pdf
St. Mary's Healthcare Provider Number: 85350 Mr. Scott Bruce, President & CEO Telephone - (518)-841-7101 Administrative Office: 427 Guy Park Avenue, Amsterdam, NY 12010
Certificate Number: 200210615 Conditional Certificate Effective: 03/01/2019 Anticipated Recert Review: 2/29/2020 Program Location: 4th Floor, 4988 State Highway 30, , Amsterdam, New York 12010 Service Type: Outpatient Service (822) PRU: 50685 Certified Capacity: 0 with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10615_StMary.pdf
September 21, 2021 Page 195 of 225 Certificate Number: 201110746 Renewal Effective: 12/01/2018 Anticipated Recert Review: 11/30/2020 Program Location: 2nd and 3rd Floors, 73 North Main Street, Gloversville, New York 12078 Service Type: Outpatient Service (822) PRU: 52614 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10746_StMary.pdf
Certificate Number: 210811404 Renewal Effective: 09/01/2018 Anticipated Recert Review: 8/31/2021 Program Location: 3rd Floor, 427 Guy Park Avenue, Amsterdam, New York 12010 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51257 Certified Capacity: 14
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11404_StMary.pdf
Certificate Number: 211011434 Amendment Effective: 09/04/2020 Anticipated Recert Review: 10/31/2021 Program Location: 4th Floor, 4988 State Highway 30, , Amsterdam, New York 12010 Service Type: Opioid Treatment Program (822) PRU: 7404 Certified Capacity: 100 with Telepractice Designation [with ancillary withdrawal services for up to 10 patients] Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11434_StMary.pdf
St. Peter's Health Partner's, as Sponsor St. Peter's Hospital of the City of Albany, as Operator Provider Number: 83060 Mr. Patrick Carrese, Director Telephone - (518)-452-6707 Administrative Office: 3 Mercycare Lane, Guilderland, NY 12084
Certificate Number: 210910254 Establishment Deemed Effective: 08/04/2020 Anticipated Recert Review: 9/22/2021 Program Location: Gabrilove Pavilion, 6th Floor, 315 South Manning Boulevard, Albany, New York 12208 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 50227 Certified Capacity: 18
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10254_StPete.pdf
Certificate Number: 210710255 Amendment Effective: 09/21/2020 Anticipated Recert Review: 7/31/2021 Program Location: 64 Second Avenue, Albany, New York 12202 Service Type: Community Residential (819) PRU: 50234 Certified Capacity: 22 with Telepractice Designation
Program Name: SPARC Halfway House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10255_StPete.pdf
September 21, 2021 Page 196 of 225 Certificate Number: 210910569 Amendment Deemed Effective: 10/06/2020 Anticipated Recert Review: 9/22/2021 Program Location: 64 Second Avenue, Albany, New York 12202 Service Type: Outpatient Service (822) PRU: 51920 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 50233 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10569_StPete.pdf
Certificate Number: 210911017 Amendment Deemed Effective: 10/06/2020 Anticipated Recert Review: 9/22/2021 Program Location: 2nd Floor, 845 Central Avenue, Albany, New York 12206 Service Type: Outpatient Service (822) PRU: 50232 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: SPARC
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11017_StPete.pdf
Certificate Number: 210911018 Amendment Deemed Effective: 10/06/2020 Anticipated Recert Review: 9/22/2021 Program Location: 55 Mohawk Street, Cohoes, New York 12047 Service Type: Outpatient Service (822) PRU: 50230 Certified Capacity: with Telepractice Designation [with ancillary withdrawal]
Program Name: SPARC
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11018_StPete.pdf
Certificate Number: 210911429 Amendment Deemed Effective: 10/06/2020 Anticipated Recert Review: 9/22/2021 Program Location: 1st Floor, 2925 Hamburg Street, Rotterdam, New York 12303 Service Type: Outpatient Service (822) PRU: 51810 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11429_StPete.pdf
Certificate Number: 210911430 Amendment Deemed Effective: 10/06/2020 Anticipated Recert Review: 9/22/2021 Program Location: 125 High Rock Avenue, Saratoga Springs, New York 12866 Service Type: Outpatient Service (822) PRU: 50928 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51925 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11430_StPete.pdf
September 21, 2021 Page 197 of 225 Certificate Number: 210911431 Amendment Deemed Effective: 09/21/2020 Anticipated Recert Review: 9/22/2021 Program Location: 636 New Loudon Road, Latham, New York 12110 Service Type: Outpatient Service (822) PRU: 50927 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11431_StPete.pdf
Certificate Number: 210711463 Amendment Deemed Effective: 09/21/2020 Anticipated Recert Review: 9/22/2021 Program Location: 1st & 2nd Floors, 3 Mercycare Lane, Guilderland, New York 12084 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51039 Certified Capacity: 40 with Telepractice Designation
Program Name: SPARC Inpatient Rehabilitation Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11463_StPete.pdf
Certificate Number: 210712116 Amendment Effective: 09/21/2020 Anticipated Recert Review: 7/31/2021 Program Location: Gabrilove Pavilion/Nolan Riddle, 6th Floor, 315 South Manning Boulevard, Albany, New York 12208 Service Type: Medically Supervised Outpatient Withdrawal & Stabilization (816.8) PRU: 53157 Certified Capacity: 45 with Telepractice Designation
Program Name: St. Peter's Hospital Detox
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12116_StPete.pdf
St. Peter's Health Partner's, as Sponsor, Samaritan Hospital of Troy, New York, as Operator Provider Number: 81140 Mr. Michael Finegan, Chief Executive Officer Telephone - (518)-525-1990 Administrative Office: 2215 Burdett Avenue, Troy, NY 12180
Certificate Number: 210712169 Establishment Effective: 08/04/2020 Anticipated Recert Review: 7/31/2021 Program Location: 4th Floor, 1300 Massachusetts Avenue, , Troy, New York 12180 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53306 Certified Capacity: 20
Program Name: St. Mary's Hospital Campus
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12169_Samari.pdf
Certificate Number: 210712170 Establishment Effective: 08/04/2020 Anticipated Recert Review: 7/31/2021 Program Location: Floor #4N, 1300 Massachusetts Avenue, , Troy, New York 12180 Service Type: Medically Supervised Outpatient Withdrawal & Stabilization (816.8) PRU: 53305 Certified Capacity: 60
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12170_Samari.pdf
START Treatment & Recovery Centers, Inc. Provider Number: 47570 Lawrence S. Brown M.D., Chief Executive Officer Telephone - (718)-260-2917 Administrative Office: 937 Fulton Street, Brooklyn, NY 11238
September 21, 2021 Page 198 of 225 Certificate Number: 230410353 Renewal Effective: 05/01/2021 Anticipated Recert Review: 4/30/2023 Program Location: 1149-55 Myrtle Avenue, Brooklyn, New York 11206 Service Type: Opioid Treatment Program (822) PRU: 80 Certified Capacity: 500 [with ancillary withdrawal services] Capacity Lifted Program Name: ARTC Bushwick MMTP
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10353_STARTT.pdf
Certificate Number: 240810355 Renewal Effective: 09/01/2021 Anticipated Recert Review: 8/31/2024 Program Location: 1st & 2nd Floors, 2191 Third Avenue, , New York, New York 10035 Service Type: Opioid Treatment Program (822) PRU: 77 Certified Capacity: 385
Program Name: Third Horizon Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10355_STARTT.pdf
Certificate Number: 221010356 Renewal Effective: 11/01/2020 Anticipated Recert Review: 10/31/2022 Program Location: 2nd and 3rd Floors, 2406 Amsterdam Avenue, , New York, New York 10033 Service Type: Opioid Treatment Program (822) PRU: 1302 Certified Capacity: 350 [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10356_STARTT.pdf
Certificate Number: 210710357 Amendment Effective: 03/04/2021 Anticipated Recert Review: 7/31/2021 Program Location: 1st Floor, 494 Dumont Avenue, Brooklyn, New York 11207 Service Type: Opioid Treatment Program (822) PRU: 78 Certified Capacity: 500 [with ancillary withdrawal services] Capacity Lifted Program Name: East New York Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10357_STARTT.pdf
Certificate Number: 210310358 Amendment Effective: 03/04/2021 Anticipated Recert Review: 3/31/2021 Program Location: 2nd and 3rd Floors, 937 Fulton Street, Brooklyn, New York 11238 Service Type: Opioid Treatment Program (822) PRU: 7 Certified Capacity: 500 [with ancillary withdrawal services] Capacity Lifted Program Name: Fort Greene Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10358_STARTT.pdf
Certificate Number: 210311563 Amendment Effective: 03/04/2021 Anticipated Recert Review: 3/31/2021 Program Location: Basement, 4th and 5th Floors, 119-121 West 124th Street, New York, New York 10027 Service Type: Opioid Treatment Program (822) PRU: 6 Certified Capacity: 300 [with ancillary withdrawal services] Capacity Lifted Program Name: Starting Point Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11563_STARTT.pdf
September 21, 2021 Page 199 of 225 Certificate Number: 230311564 Amendment Effective: 03/04/2021 Anticipated Recert Review: 3/31/2023 Program Location: Basement, 2nd and 3rd Floors, 119-121 West 124th Street, New York, New York 10027 Service Type: Opioid Treatment Program (822) PRU: 8 Certified Capacity: 300 [with ancillary withdrawal services] Capacity Lifted Program Name: Kaleidoscope Clinic
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11564_STARTT.pdf
Certificate Number: 210111572 Renewal Effective: 02/01/2019 Anticipated Recert Review: 1/31/2021 Program Location: 6th Floor, 119-121 West 124th Street, New York, New York 10027 Service Type: Outpatient Service (822) PRU: 52059 Certified Capacity: [with ancillary withdrawal services]
Program Name: REACH Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11572_STARTT.pdf
State University of New York at Buffalo Provider Number: 30560 Kenneth E. Leonard Ph.D., Director, Research Telephone - (716)-887-2509 Administrative Office: Institute on Addictions Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203
Certificate Number: 211211025 Renewal Effective: 01/01/2020 Anticipated Recert Review: 12/31/2021 Program Location: Research Institute on Addictions, 1st and 2nd Floors, 1021 Main Street, Buffalo, New York 14203 Service Type: Chemical Dependency Specialized Services (824) PRU: 52735 Certified Capacity:
Program Name: University at Buffalo's Addiction Treatment Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11025_StateU.pdf
Steuben County Alcoholism and Substance Abuse Services Provider Number: 70640 Henry Chapman Psy.D., Director Telephone - (607)-664-2156 Administrative Office: 115 Liberty Street, Bath, NY 14810
Certificate Number: 220311030 Amendment Effective: 10/28/2020 Anticipated Recert Review: 3/31/2022 Program Location: 4th Floor, 115 Liberty Street, Bath, New York 14810 Service Type: Outpatient Service (822) PRU: 50913 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11030_Steube.pdf
Certificate Number: 201111031 Amendment Effective: 10/28/2020 Anticipated Recert Review: 11/30/2020 Program Location: 114 Chestnut Street, Corning, New York 14830 Service Type: Outpatient Service (822) PRU: 50914 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11031_Steube.pdf
September 21, 2021 Page 200 of 225 Certificate Number: 220611658 Amendment Effective: 10/28/2020 Anticipated Recert Review: 6/30/2022 Program Location: 1st Floor, 7454 Seneca Road, Hornell, New York 14843 Service Type: Outpatient Service (822) PRU: 52186 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11658_Steube.pdf
Strong Memorial Hospital Provider Number: 87080 Mr. Steven I. Goldstein, Chief Executive Officer Telephone - (585)-275-7685 Administrative Office: Room 1-4336, 601 Elmwood Avenue, Rochester, NY 14642
Certificate Number: 210710465 Amendment Deemed Effective: 06/10/2020 Anticipated Recert Review: 7/31/2021 Program Location: 2613 West Henrietta Road, , Rochester, New York 14623 Service Type: Opioid Medical Maintenance (822) PRU: 7365 Certified Capacity:
Program Name:
Service Type: Opioid Treatment Program (822) PRU: 665 Certified Capacity: 500 with Telepractice Designation [with ancillary withdrawal services for up to 50 patients] Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10465_Strong.pdf
Certificate Number: 220411095 Amendment OASAS Host Effective: 06/10/2020 Anticipated Recert Review: 4/6/2022 Program Location: Suite C & D, 2613 West Henrietta Road, , Rochester, New York 14623 Service Type: Outpatient Service (822) PRU: 53464 Certified Capacity: 0 withTelepractice Designation [with ancillary withdrawal services]
Program Name: AYA (Adolescents/Young Adults) Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11095_Strong.pdf
Student Assistance Services Corporation Provider Number: 34310 Ms. Ellen R. Morehouse, Executive Director Telephone - (914)-332-1300 Administrative Office: 1st Floor, 660 White Plains Road, Tarrytown, NY 10591
Certificate Number: 220111978 Amendment Effective: 09/01/2021 Anticipated Recert Review: 1/31/2022 Program Location: 1st Floor, 660 White Plains Road, Tarrytown, New York 10591 Service Type: Prevention Counseling PRU: 90672 Certified Capacity: with Telepractice Designation
Program Name: Student Assistance Services
Pierre Van Cortlandt Middle School, 3 Glen Place, Croton-on-Hudson, NY 10520 Other Service Site(s) At:
September 21, 2021 Page 201 of 225 Byram Hills High School, 12 Tripp Lane, Armonk, NY 10504 Other Service Site(s) At: Horace Greeley High School D Building, 70 Roaring Brook Road, Chappaqua, NY 10514 Other Service Site(s) At: Yonkers High School, 150 Rockland Avenue, Yonkers, NY 10705 Other Service Site(s) At: Saunders Trade and Technical High School, 183 Palmer Road, Yonkers, NY 10701 Other Service Site(s) At: Yonkers Montessori Academy, 160 Woodlawn Avenue, Yonkers, NY 10704 Other Service Site(s) At: Alexander Hamilton Junior/Senior High School, South Goodwin Avenue, Elmsford, NY 10523 Other Service Site(s) At: Peekskill Middle School, 212 Ringgold Street, Peekskill, NY 10566 Other Service Site(s) At: Riverside High School, 565 Warburton Avenue, Yonkers, NY 10701 Other Service Site(s) At: White Plains High School, 550 North Street, White Plains, NY 10605 Other Service Site(s) At: Blue Mountain Middle School, 7 Furnace Woods Road, Cortlandt Manor, NY 10567 Other Service Site(s) At: Dobbs Ferry Senior High School, 505 Broadway, Dobbs Ferry, NY 10522 Other Service Site(s) At: Palisades Preparatory School, 201 Palisade Avenue, Yonkers, NY 10703 Other Service Site(s) At: Lakeland Copper Beach Middle School, 3401 Old Yorktown Road, Yorktown Heights, NY 10598 Other Service Site(s) At: Somers High School, Route 139, Lincolndale, NY 10540 Other Service Site(s) At: Croton-Harmon High School, 36 Old Post Road South, Croton-on-Hudson, NY 10520 Other Service Site(s) At: Walter Panas High School, 300 Croton Avenue, Cortland Manor, NY 10566 Other Service Site(s) At: Hendrick Hudson High School, Albany Post Road, Montrose, NY 10548 Other Service Site(s) At: Briarcliff Middle School, 444 Pleasantville Road, Briarcliff Manor, NY 10510 Other Service Site(s) At: Peekskill High School, 1072 Elm Street, Peekskill, NY 10566 Other Service Site(s) At: Gorton High School, 100 Shonnard Place, Yonkers, NY 10703 Other Service Site(s) At: Briarcliff High School, 445 Pleasantville Road, Briarclliff, NY 10510 Other Service Site(s) At: New Rochelle High School, 265 Clove Road, New Rochelle, NY 10801 Other Service Site(s) At: Ardsley Middle School, 700 Ashford Avenue, Ardsley, NY 10502 Other Service Site(s) At: Pelham High School, 575 Colonial Avenue, Pelham, NY 10803 Other Service Site(s) At:
September 21, 2021 Page 202 of 225 Harrison High School, 255 Union Street, Harrison, NY 10528 Other Service Site(s) At: Yorktown High School, 2727 Crompond Road, Yorktown Heights, NY 10598 Other Service Site(s) At: Roosevelt High School, 631 Tuckahoe Road, Yonkers, NY 10710 Other Service Site(s) At: Lakeland High School, 1349 East Main Street, Shrub Oak, NY 10588 Other Service Site(s) At: Sleepy Hollow High School, 210 North Broadway, North Tarrytown, NY 10591 Other Service Site(s) At: Fox Lane High School, South Bedford Road, Bedford, NY 10506 Other Service Site(s) At: Pelham Middle School, 28 Franklin Place, Pelham, NY 10803 Other Service Site(s) At: Irvington High School, 40 North Broadway, Irvington, NY 10536 Other Service Site(s) At: Lincoln High School, 375 Kneeland Avenue, Yonkers, NY 10704 Other Service Site(s) At: Blindbrook High School, 840 King Street, Rye Brook, NY 10573 Other Service Site(s) At: White Plains Middle School/Highlands, 128 Grandview Avenue, White Plains, NY 10605 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11978_Studen.pdf
Substance Abuse Prevention Team of Essex County, Inc. Provider Number: 2185 Mr. Douglas Terbeek, Executive Director Telephone - (518)-585-7424 Ext 101 Administrative Office: 173 Lord Howe Street, Ticonderoga, NY 12883
Certificate Number: 240312007 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: 173 Lord Howe Street, Ticonderoga, New York 12883 Service Type: Prevention Counseling PRU: 90642 Certified Capacity:
Program Name:
Moriah Central School, Elementary Wing, 2nd Floor, Room 218, 39 Viking Lane, Port Henry, NY 12974 Other Service Site(s) At: Willsboro Central School, 1st Floor, Room E127, 29 School Lane, Willsboro, NY 12996 Other Service Site(s) At: Lake Placid Junior/Senior High School, 4th Floor, Room 305, 34 School Street, Lake Placid, NY 12946 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12007_Substa.pdf
Success Counseling Services, Inc. Provider Number: 29070 Mr Josh Greenfeld, CEO Telephone - (718)-538-6112 Administrative Office: 1015 Ogden Avenue, Bronx, NY 10452
September 21, 2021 Page 203 of 225 Certificate Number: 220411032 Amendment Effective: 08/16/2021 Anticipated Recert Review: 4/30/2022 Program Location: 1015-1017 Ogden Avenue, , Bronx, New York 10452 Service Type: Outpatient Service (822) PRU: 51788 Certified Capacity: with Telepractice Designation
Program Name:
Success Counseling Services, Inc., 1038 Ogden Avenue, Bronx, NY 10452 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11032_Succes.pdf
Suffolk County Department of Health Services Provider Number: 70370 Ms. Cari F. Besserman, Director Telephone - (631)-853-3108 Administrative Office: William J. Lindsay Complex - Bldg C016, 725 Veterans Memorial Highway, P.O. Box 6100, Hauppauge, NY 11788
Certificate Number: 230310392 Amendment Effective: 09/09/2020 Anticipated Recert Review: 3/31/2023 Program Location: 200 Wireless Boulevard, Hauppauge, New York 11788 Service Type: Opioid Treatment Program (822) PRU: 3097 Certified Capacity: 300 with Telepratice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10392_Suffol.pdf
Certificate Number: 211010393 Amendment Effective: 09/09/2020 Anticipated Recert Review: 10/31/2021 Program Location: 2nd Floor, 300 Center Drive, Riverhead, New York 11901 Service Type: Opioid Treatment Program (822) PRU: 6731 Certified Capacity: 275 with Telepractice Designation
Program Name: Division of Community Mental Hygiene Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10393_Suffol.pdf
Certificate Number: 210210394 Amendment Effective: 09/09/2020 Anticipated Recert Review: 2/28/2021 Program Location: 689 East Jericho Turnpike, Huntington Station, New York 11746 Service Type: Opioid Treatment Program (822) PRU: 202 Certified Capacity: 300 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10394_Suffol.pdf
Certificate Number: 210910395 Amendment Effective: 09/09/2020 Anticipated Recert Review: 9/30/2021 Program Location: William J. Lindsay Complex, Building 151, 725 Veterans Memorial Highway, , Smithtown, New York 11787 Service Type: Opioid Treatment Program (822) PRU: 201 Certified Capacity: 300 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10395_Suffol.pdf
September 21, 2021 Page 204 of 225 Sullivan County Department of Community Services Provider Number: 70170 Ms. Melissa Stickle LCSW-R, CASAC, Director Telephone - (845)-292-8770 Ext 2097 Administrative Office: 20 Community Lane, PO Box 716, Liberty, NY 12754
Certificate Number: 210610595 Amendment OMH Host Effective: 03/19/2019 Anticipated Recert Review: 6/30/2021 Program Location: 2nd Floor, 20 Community Lane, Liberty, New York 12754 Service Type: Outpatient Service (822) PRU: 50430 Certified Capacity: 0 with telepractice designation
Program Name: Sullivan County Alcohol and Drug Abuse Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10595_Sulliv.pdf
Syracuse Community Health Center, Inc. Provider Number: 36260 Mr. Mark Hall, President & CEO Telephone - (315)-476-0642 Administrative Office: 819 South Salina Street, Syracuse, NY 13202
Certificate Number: 210511039 Renewal Effective: 06/01/2019 Anticipated Recert Review: 5/31/2021 Program Location: 1st Floor, 819 South Salina Street, Syracuse, New York 13202 Service Type: Outpatient Service (822) PRU: 50934 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11039_Syracu.pdf
Syracuse Recovery Services, LLC Provider Number: 47230 Ms. Lisa J. Forshee, Director Telephone - (315)-282-5351 Administrative Office: 319 East Water Street, Syracuse, NY 13202
Certificate Number: 220911710 Amendment Effective: 07/01/2020 Anticipated Recert Review: 9/30/2022 Program Location: 319 East Water Street, Syracuse, New York 13202 Service Type: Outpatient Service (822) PRU: 52520 Certified Capacity: with Telepractice Designation
Program Name:
Euclid Med Bldg, 1st Floor, Suite 5, 6 Euclid Avenue, Cortland, NY 13045 Additional Location(s) At: 180 Genesee Street, Auburn, NY 13021 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11710_Syracu.pdf
T.R.I. Center, Inc. Provider Number: 16350 Mr. Jose Gonzalez, President and CEO Telephone - (212)-268-8830 Administrative Office: 1369 Broadway, New York, NY 10018
September 21, 2021 Page 205 of 225 Certificate Number: 210711041 Amendment Effective: 07/01/2020 Anticipated Recert Review: 7/31/2021 Program Location: 2nd and 3rd Floors, 1369 Broadway, New York, New York 10018 Service Type: Outpatient Service (822) PRU: 6015 Certified Capacity: with Telepractice Designation
Program Name: Service Type: Outpatient Rehabilitation Service (822) PRU: 51959 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11041_TRICen.pdf
Certificate Number: 220111465 Amendment Effective: 04/12/2021 Anticipated Recert Review: 1/31/2022 Program Location: 11th Floor, 175 Remsen Street, , Brooklyn, New York 11201 Service Type: Outpatient Service (822) PRU: 6402 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11465_TRICen.pdf
Certificate Number: 231211466 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2023 Program Location: Suite 415-423, 2488 Grand Concourse, Bronx, New York 10458 Service Type: Outpatient Service (822) PRU: 6134 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11466_TRICen.pdf
Tempo Group, Inc. Provider Number: 313 Ms. Cindy Wolff, Executive Director Telephone - (516)-374-3671 Administrative Office: 112 Franklin Place, Woodmere, NY 11598
Certificate Number: 11030922 Amendment Effective: 06/30/2007 Anticipated Recert Review: SAPA Program Location: 112 Franklin Place, Woodmere, New York 11598 Service Type: Drug-Free Prevention (1030.3) PRU: 90583 Certified Capacity:
Program Name: Woodmere Clinic
John F. Kennedy High School, 1st Floor, Room 131, 3000 Bellmore Avenue, Bellmore, NY 11710 Other Service Site(s) At: Grand Avenue Middle School, 1st Floor, Room 127, 2301 Grand Avenue, Bellmore, NY 11710 Other Service Site(s) At: Sanford H. Calhoun High School, 1st Floor, Room 113, 1786 State Street, Merrick, NY 11566 Other Service Site(s) At: Wellington C. Mepham High School, 1st Floor, Social Worker's Office, 2401 Camp Avenue, Bellmore, NY 11710 Other Service Site(s) At: Merrick Middle School, 1st Floor, Social Worker's Office, 1870 Merrick Avenue, Merrick, NY 11566 Other Service Site(s) At:
September 21, 2021 Page 206 of 225 1st Floor, 1260 Meadowbrook Road, North Merrick, NY 11566 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/00922_TempoG.pdf
Certificate Number: 200911043 Amendment Effective: 05/15/2020 Anticipated Recert Review: 9/30/2020 Program Location: 112 Franklin Place, Woodmere, New York 11598 Service Type: Outpatient Service (822) PRU: 7066 Certified Capacity: with Telepractice Designation
Program Name: Woodmere Clinic
1st Floor, 1260 Meadowbrook Road, North Merrick, NY 11566 Additional Location(s) At: 23 Willis Avenue, Syosset, NY 11791 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11043_TempoG.pdf
Tioga County Community Services Board Provider Number: 70510 Ms Lori Morgan, Director of Community Services Telephone - (607)-689-8139 Administrative Office: 1062 State Route 38, P.O. Box 177, Owego, NY 13827
Certificate Number: 211111080 Amendment Effective: 06/22/2020 Anticipated Recert Review: 11/30/2021 Program Location: 1st Floor, 1062 NYS Route 38, , Owego, New York 13827 Service Type: Outpatient Service (822) PRU: 554 Certified Capacity: with Telepractice Designation
Program Name: Tioga County Alcohol & Drug Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11080_TiogaC.pdf
Town of Babylon Provider Number: 372 Mr. Joseph Olmedo, Director Telephone - (631)-422-7676 Administrative Office: Babylon Town Hall, 1st Floor, 200 East Sunrise Highway, Lindenhurst, NY 11757
Certificate Number: 231211544 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2023 Program Location: 281 Phelps Lane , North Babylon, New York 11703 Service Type: Outpatient Service (822) PRU: 560 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Lindenhurst High School, Adult Education Suite, 300 Charles Street, Lindenhurst, NY 11757 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11544_Townof.pdf
Town of Smithtown Provider Number: 667 Mr Matthew Neebe, Executive Director Telephone - (631)-360-7578 Administrative Office: 161 East Main Street, Smithtown, NY 11787
September 21, 2021 Page 207 of 225 Certificate Number: 220711084 Amendment Effective: 07/10/2020 Anticipated Recert Review: 7/31/2022 Program Location: 161 East Main Street, Smithtown, New York 11787 Service Type: Outpatient Service (822) PRU: 7116 Certified Capacity: with Telepractice Designation
Program Name: Horizons Counseling & Education Center
Hauppauge High School, Room #144, 500 Lincoln Boulevard, Hauppauge, NY 11788 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11084_Townof.pdf
Trinity Alliance of the Capital Region, Inc. Provider Number: 24440 Mr. Harris Oberlander, Chief Executive Officer Telephone - (518)-449-5155 Ext 116 Administrative Office: 15 Trinity Place, Albany, NY 12202
Certificate Number: 240212146 Renewal Effective: 03/01/2021 Anticipated Recert Review: 2/29/2024 Program Location: 76-82 2nd Street, Albany, New York 12210 Service Type: Residential Services (820) PRU: 53244 Certified Capacity: 20
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12146_Trinit.pdf
Triumph Treatment LLC Provider Number: 50670 Mr. Edward Rebenwurzel, Managing Partner Telephone - (347)-524-1832 Administrative Office: 2808 Avenue P, Brooklyn, NY 11229
Certificate Number: 200112168 Establishment Effective: 02/01/2019 Anticipated Recert Review: 1/31/2020 Program Location: 2nd Floor, 309 West Park Avenue, , Long Beach, New York 11561 Service Type: Opioid Treatment Program (822) PRU: 53303 Certified Capacity: 25
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12168_Triump.pdf
The Tully Hill Corporation Provider Number: 32611 s.. Cathy L. Palm, Executive Director Telephone - (315)-696-6114 Administrative Office: 5821 State Route 80, P.O. Box 1116, Tully, NY 13159
Certificate Number: 221110102 Renewal Effective: 12/01/2019 Anticipated Recert Review: 11/30/2022 Program Location: 5821 State Route 80, , Tully, New York 13159 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 8050 Certified Capacity: 8
Program Name: The Tully Hill Corporation
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10102_TullyH.pdf
September 21, 2021 Page 208 of 225 Certificate Number: 201211073 Amendment Effective: 03/03/2020 Anticipated Recert Review: 12/31/2020 Program Location: 5821 State Route 80, , Tully, New York 13159 Service Type: Outpatient Service (822) PRU: 51660 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: The Tully Hill Corporation
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11073_TullyH.pdf
Certificate Number: 230111418 Renewal Effective: 02/01/2020 Anticipated Recert Review: 1/31/2023 Program Location: 5821 State Route 80, , Tully, New York 13159 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 51062 Certified Capacity: 42
Program Name: The Tully Hill Corporation
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11418_TullyH.pdf
Twin County Recovery Services, Inc. Provider Number: 35010 Ms. Tina Yun Lee, Executive Director Telephone - (518)-751-2083 Ext 1140 Administrative Office: 350 Powers Avenue, Hudson, NY 12534
Certificate Number: 181210122 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 437-441 Columbia Street, Hudson, New York 12534 Service Type: Community Residential (819) PRU: 51164 Certified Capacity: 13 with Telepractice Designation
Program Name: The Red Door Community Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10122_TwinCo.pdf
Certificate Number: 181210339 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: Grade Level, 428 West Main Street, Catskill, New York 12414 Service Type: Community Residential (819) PRU: 51765 Certified Capacity: 12 [maximum certified occupancy can be no more than 16 persons] with Telepractice Designation and up to 6 beds for children Program Name: Riverside Recovery Residence
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10339_TwinCo.pdf
Certificate Number: 210211087 Amendment Effective: 09/09/2020 Anticipated Recert Review: 2/28/2021 Program Location: 1st Floor, 428 West Main Street, Catskill, New York 12414 Service Type: Outpatient Service (822) PRU: 6865 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11087_TwinCo.pdf
September 21, 2021 Page 209 of 225 Certificate Number: 220111088 Amendment Effective: 09/09/2020 Anticipated Recert Review: 1/31/2022 Program Location: 350 Power Avenue, Hudson, New York 12534 Service Type: Outpatient Service (822) PRU: 50146 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11088_TwinCo.pdf
Certificate Number: 210111981 Amendment Effective: 09/09/2020 Anticipated Recert Review: 1/31/2021 Program Location: Administrative Site Only:, 388 Main Street, , Catskill, New York 12414 Service Type: Prevention Counseling PRU: 90675 Certified Capacity: with Telepractice Designation
Program Name:
Cairo-Durham CSD, High School Main Office, 1301 Route 145, Cairo, NY 12413 Other Service Site(s) At: Coxsackie-Athens School, 1st Floor, Counselor's Suite, 24 Sunset Boulevard, Coxsackie, NY 12051 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11981_TwinCo.pdf
Unitas Therapeutic Community, Inc. Provider Number: 1537 Ian S. Amritt Ph.D., Executive Director Telephone - (718)-589-0551 Ext 1005 Administrative Office: 4th Floor, 830 Southern Boulevard, Bronx, NY 10459
Certificate Number: 220811980 Renewal Effective: 09/01/2019 Anticipated Recert Review: 8/31/2022 Program Location: St. Athanasius School, 830 Southern Boulevard, Bronx, New York 10459 Service Type: Prevention Counseling PRU: 90746 Certified Capacity:
Program Name:
The Hyde Charter School, 4th Floor, 730 Bryant Avenue, Bronx, NY 10474 Other Service Site(s) At: The Bronx Studio School for Writers and Artists, 928 Simpson Street, Bronx, NY 10459 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11980_Unitas.pdf
United Activities Unlimited, Inc. Provider Number: 1786 Louis DeLuca Ed.D., CEO Telephone - (718)-987-8111 Administrative Office: Building P, 3rd Floor, 1000 Richmond Terrace, Staten Island, NY 10301
Certificate Number: 240312033 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: Administrative Site Only:, Building P, Floor #3, 1000 Richmond Terrace, Staten Island, New York 10301 Service Type: Prevention Counseling PRU: 90749 Certified Capacity:
Program Name:
P.S. 4, 1st Floor, Room 123, 200 Nedra Lane, Staten Island, NY 10312 Other Service Site(s) At:
September 21, 2021 Page 210 of 225 I.S. 51, 2nd Floor, Room 254, 20 Houston Street, Staten Island, NY 10302 Other Service Site(s) At: P.S. 56, 1st Floor, Counseling Room, 250 Kramer Avenue, Staten Island, NY 10309 Other Service Site(s) At: I.S. 7, 1st Floor, Room 136, 1270 Huguenot Avenue, Staten Island, NY 10312 Other Service Site(s) At: P.S. 19, 1st Floor, Room 105, 780 Post Avenue, Staten Island, NY 10310 Other Service Site(s) At: I.S. 75, 1st Floor, Room 111, 455 Huguenot Avenue, Staten Island, NY 10312 Other Service Site(s) At: I.S. 2, 1st Floor, Counseling Room, 333 Midland Avenue, Staten Island, NY 10306 Other Service Site(s) At: I.S. 34, 3rd Floor, Room 4037, 528 Academy Avenue, Staten Island, NY 10307 Other Service Site(s) At: P.S. 52, 1st Floor, Room 121, 480 Buel Avenue, Staten Island, NY 10305 Other Service Site(s) At: PS 20, 161 Park Avenue, Staten Island, NY 10302 Other Service Site(s) At: I.S. 72, 1st Floor, Room 128, 33 Ferndale Avenue, Staten Island, NY 10314 Other Service Site(s) At: PS 55, 54 Osborne Avenue, Staten Island, NY 10302 Other Service Site(s) At: New Dorp HS, 465 New Dorp Lane, Staten Island, NY 10306 Other Service Site(s) At: Todt Hill Houses - Building #4, 1st Floor, Community Room, 263 Westwood Avenue, Staten Island, NY 10314 Other Service Site(s) At: P.S. 18, 1st Floor, Room 14, 221 Broadway, Staten Island, NY 10310 Other Service Site(s) At: P.S. 44, 1st Floor, Room 2066, 80 Maple Parkway, Staten Island, NY 10303 Other Service Site(s) At: I.S. 24, 1st Floor, Counseling Room, 225 Cleveland Avenue, Staten Island, NY 10308 Other Service Site(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12033_United.pdf
United Health Services Hospitals, Inc. Provider Number: 85330 Mr. John J. Carrigg, President and Chief Executive Telephone - (607)-762-2260 Administrative Office: Officer 10-42 Mitchell Avenue, Binghamton, NY 13903
Certificate Number: 231110451 Renewal Effective: 12/01/2020 Anticipated Recert Review: 11/30/2023 Program Location: Binghamton General Hospital, Ground Level, 10-42 Mitchell Avenue, Binghamton, New York 13903 Service Type: Opioid Treatment Program (822) PRU: 691 Certified Capacity: 150 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10451_United.pdf
September 21, 2021 Page 211 of 225 Certificate Number: 220111094 Amendment Effective: 05/28/2020 Anticipated Recert Review: 1/31/2022 Program Location: Binghamton General Hospital, 2nd Floor, 10-42 Mitchell Avenue, Binghamton, New York 13903 Service Type: Outpatient Service (822) PRU: 50599 Certified Capacity: with Telepractice Designation
Program Name: New Horizons Chemical Dependency Treatment Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11094_United.pdf
Certificate Number: 211211421 Amendment Deemed Effective: 05/28/2020 Anticipated Recert Review: 12/8/2021 Program Location: Binghamton General Hospital, Memorial 4, 10-42 Mitchell Avenue, Binghamton, New York 13903 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50598 Certified Capacity: 20 with Telepractice Designation
Program Name: New Horizons Chemical Dependency Treatment Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11421_United.pdf
United Memorial Medical Center Provider Number: 82230 Ms. Mandy Teeter, Vice President, Rochester Telephone - Administrative Office: Regional Health-Behavioral Health 127 North Street, Batavia, NY 14020
Certificate Number: 231011857 Renewal Deemed Effective: 10/03/2020 Anticipated Recert Review: 10/3/2023 Program Location: 2nd Floor, 16 Bank Street, Batavia, New York 14020 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50957 Certified Capacity: 22 with Telepractice Designation
Program Name: Hope Haven
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11857_United.pdf
The Unity Hospital of Rochester Provider Number: 83250 Ms. Mandy Teeter, Vice President, Rochester Telephone - (585)-368-6989 Administrative Office: Regional Health-Behavioral Health Evelyn Brandon Health Center, 3rd Floor, 81 Lake Avenue, Rochester, NY 14608
Certificate Number: 210510517 Amendment Deemed Effective: 09/10/2020 Anticipated Recert Review: 5/12/2021 Program Location: Chemical Dependency Building, 1565 Long Pond Road, Rochester, New York 14626 Service Type: Medically Supervised Outpatient Withdrawal & Stabilization (816.8) PRU: 8043 Certified Capacity: 9 [without the use of methadone] with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10517_UnityH.pdf
Certificate Number: 220210921 Amendment Deemed Effective: 09/10/2020 Anticipated Recert Review: 2/28/2022 Program Location: Chemical Dependency Building, 1565 Long Pond Road, Rochester, New York 14626 Service Type: Outpatient Service (822) PRU: 50762 Certified Capacity: with Telepractice Designation
Program Name:
September 21, 2021 Page 212 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10921_UnityH.pdf
Certificate Number: 220110922 Amendment Deemed Effective: 08/04/2021 Anticipated Recert Review: 1/31/2022 Program Location: Building 2, 1st Floor, 2000 Winton Road South, , Rochester, New York 14618 Service Type: Outpatient Service (822) PRU: 50764 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10922_UnityH.pdf
Certificate Number: 230210923 Renewal Deemed Effective: 03/01/2020 Anticipated Recert Review: 2/28/2023 Program Location: 2nd Floor, 81 Lake Avenue, Rochester, New York 14608 Service Type: Outpatient Service (822) PRU: 51607 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10923_UnityH.pdf
Certificate Number: 210511391 Amendment Deemed Effective: 09/10/2020 Anticipated Recert Review: 5/12/2021 Program Location: Chemical Dependency Building, 1565 Long Pond Road, Rochester, New York 14626 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50904 Certified Capacity: 40 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11391_UnityH.pdf
Unity House of Cayuga County, Inc. Provider Number: 23570 Ms. Elizabeth Smith, Executive Director Telephone - (315)-253-6227 Ext 320 Administrative Office: Administrative Offices only, Suite 14, 217 Genesee Street, Auburn, NY 13021
Certificate Number: 181210067 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 58 Osborne Street, Auburn, New York 13021 Service Type: Supportive Living (819) PRU: 51701 Certified Capacity: 19
Program Name: Unity House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10067_UnityH.pdf
Certificate Number: 181210068 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 58 Osborne Street, Auburn, New York 13021 Service Type: Community Residential (819) PRU: 51176 Certified Capacity: 16
Program Name: Grace House
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10068_UnityH.pdf
September 21, 2021 Page 213 of 225 University Hospital - Stony Brook Eastern Long Island Hospital Provider Number: 81310 Ms. Carol Gomes, Interim Chief Executive Officer Telephone - (631)-444-2701 Administrative Office: Room 221, Level 4, 101 Nicolls Road, Stony Brook, NY 11794
Certificate Number: 200610227 Amendment Deemed Effective: 08/06/2019 Anticipated Recert Review: 6/30/2020 Program Location: 2nd Floor, 201 Manor Place, , Greenport, New York 11944 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 51661 Certified Capacity: 10
Program Name: Quannacut Detoxification Unit at Stony Brook Eastern Long Island Hospital
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10227_StonyB.pdf
Certificate Number: 200611053 Amendment Deemed Effective: 05/29/2020 Anticipated Recert Review: 6/30/2020 Program Location: 905 East Main Street, , Riverhead, New York 11901 Service Type: Outpatient Service (822) PRU: 51122 Certified Capacity: with Telepractice Designation
Program Name: Stony Brook Medicine - Quannacut Outpatient Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11053_Univer.pdf
Certificate Number: 200611411 Amendment Deemed Effective: 08/06/2019 Anticipated Recert Review: 6/30/2020 Program Location: 2nd Floor, 201 Manor Place, , Greenport, New York 11944 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 50845 Certified Capacity: 20
Program Name: Quannacut Inpatient Services at Stony Brook Eastern Long Island Hospital
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11411_Univer.pdf
UPMC Chautauqua Services, Inc. as Sponsor UPMC Chautauqua at WCA as Operator Provider Number: 81610 Mr. Brian Durniok, President and Chief Executive Telephone - (716)-664-8421 Administrative Office: Officer 207 Foote Avenue, P.O. Box 840, Jamestown, NY 14701
Certificate Number: 210112054 Amendment Effective: 07/23/2018 Anticipated Recert Review: 1/31/2021 Program Location: 2M Main Floor, 51 Glasgow Avenue, Jamestown, New York 14701 Service Type: Outpatient Service (822) PRU: 53048 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: UPMC Chautauqua WCA OP
306 Central Avenue, Dunkirk, NY 14048 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12054_UPMCCh.pdf
Certificate Number: 210112055 Renewal Deemed Effective: 04/26/2018 Anticipated Recert Review: 1/27/2021 Program Location: 4th Floor, 207 Foote Avenue, Jamestown, New York 14701 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53049 Certified Capacity: 15
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12055_UPMCCH.pdf
September 21, 2021 Page 214 of 225 Certificate Number: 200612204 Establishment Effective: 07/17/2019 Anticipated Recert Review: 6/30/2020 Program Location: 4th Floor Main, 51 Glasgow Avenue, , Jamestown, New York 14701 Service Type: Residential Services (820) PRU: 53338 Certified Capacity: 20
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name: UPMC Behavioral Health Wellness Center
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12204_UPMCCh.pdf
Upper Manhattan Mental Health Center, Inc. Provider Number: 70490 Mr. Thomas Haggerty Jr., Executive Director Telephone - (212)-694-9200 Administrative Office: 1727 Amsterdam Avenue, New York, NY 10031
Certificate Number: 181210213 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 2009 3rd Avenue, New York, New York 10029 Service Type: Community Residential (819) PRU: 51809 Certified Capacity: 20 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10213_UpperM.pdf
Certificate Number: 210711097 Amendment Effective: 06/22/2020 Anticipated Recert Review: 7/31/2021 Program Location: 3rd Floor, 1727 Amsterdam Avenue, New York, New York 10031 Service Type: Outpatient Service (822) PRU: 50962 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Alcoholism & Substance Abuse Treatment Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11097_UpperM.pdf
Urban Recovery House LLC Provider Number: 50560 Mr. David Glick, CEO Telephone - (646)-960-6656 Administrative Office: 411 Van Brunt Street, Brooklyn, NY 11231
Certificate Number: 220112163 Renewal Effective: 02/01/2020 Anticipated Recert Review: 1/31/2022 Program Location: 1st - 5th Floors, 411 Van Brunt Street, , Brooklyn, New York 11231 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 53294 Certified Capacity: 30 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12163_UrbanR.pdf
Certificate Number: 211212175 Renewal Effective: 01/01/2020 Anticipated Recert Review: 12/31/2021 Program Location: 1st Floor, 411 Van Brunt Street, , Brooklyn, New York 11231 Service Type: Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) PRU: 53295 Certified Capacity: 6 with Telepractice Designation [with the use of methadone]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12175_UrbanR.pdf
September 21, 2021 Page 215 of 225 VERTEX LLC Provider Number: 44120 Mr. Paul Henderson, Executive Director Telephone - (718)-653-1117 Administrative Office: 1080 East Gun Hill Road, Bronx, NY 10469
Certificate Number: 200811484 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 8/31/2020 Program Location: 1st & 2nd Floors, 1080 East Gun Hill Road, Bronx, New York 10469 Service Type: Outpatient Service (822) PRU: 51992 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11484_VERTEX.pdf
Veterans Outreach Center, Inc. Provider Number: 43890 Ms. Laura Stradley, Executive Director Telephone - (585)-295-7800 Administrative Office: 459 South Avenue, Rochester, NY 14620
Certificate Number: 190711471 Amendment Effective: 11/09/2018 Anticipated Recert Review: 7/31/2019 Program Location: Administrative Site:, 290 Cypress Street, , Rochester, New York 14620 Service Type: Supportive Living (819) PRU: 51991 Certified Capacity: 6
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11471_Vetera.pdf
Vida Family Services, Inc. Provider Number: 1249 Mr. Christopher Nazario, Executive Director Telephone - (929)-300-4867 Ext 18 Administrative Office: 127 East 105th Street, New York, NY 10029
Certificate Number: 221211100 Renewal Effective: 01/01/2021 Anticipated Recert Review: 12/31/2022 Program Location: 127 East 105th Street, New York, New York 10029 Service Type: Outpatient Service (822) PRU: 7179 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11100_VidaFa.pdf
Villa of Hope Provider Number: 37220 Ms. Christina M. Gullo, Chief Executive Telephone - (585)-865-1550 Ext 100 Administrative Office: Officer/President 3300 Dewey Avenue, Rochester, NY 14616
Certificate Number: 210411362 Amendment OMH Host Effective: 09/01/2020 Anticipated Recert Review: 4/30/2021 Program Location: Building J, Room 202, 2nd Floor, 1099 Jay Street, Rochester, New York 14611 Service Type: Outpatient Service (822) PRU: 51886 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11362_Villao.pdf
September 21, 2021 Page 216 of 225 Certificate Number: 211211629 Amendment Effective: 09/01/2020 Anticipated Recert Review: 12/31/2021 Program Location: Life Residence, 3300 Dewey Avenue, , Rochester, New York 14616 Service Type: Residential Rehabilitation Services for Youth (817) PRU: 4856 Certified Capacity: 14 with Telepractice Designation
Program Name: Life Program
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11629_Villao.pdf
Certificate Number: 220412265 Establishment Effective: 05/17/2021 Anticipated Recert Review: 4/30/2022 Program Location: 3300 Dewey Avenue, , Rochester, New York 14616 Service Type: Community Psychiatric Support & Treatment (CPST) PRU: 53552 Certified Capacity:
Program Name:
Service Type: Other Licensed Practitioners PRU: 53556 Certified Capacity:
Program Name:
Service Type: Psychosocial Rehabilitation (PSR) PRU: 53553 Certified Capacity:
Program Name:
Service Type: Family Peer Support and Services PRU: 53554 Certified Capacity:
Program Name:
Service Type: Youth Peer Support and Training PRU: 53555 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12265_Villao.pdf
Villa Veritas Foundation, Inc. Provider Number: 47750 Ms. Suzanne Cusack, Executive Director Telephone - (845)-626-3555 Administrative Office: 5 Ridgeview Road, Kerhonkson, NY 12446
Certificate Number: 220111752 Renewal Effective: 02/01/2020 Anticipated Recert Review: 1/31/2022 Program Location: 5 Ridgeview Road, , Kerhonkson, New York 12446 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 52585 Certified Capacity: 35
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11752_VillaV.pdf
Certificate Number: 190311864 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 3/31/2019 Program Location: 5 Ridgeview Road, , Kerhonkson, New York 12446 Service Type: Intensive Residential Rehabilitation (819) PRU: 52803 Certified Capacity: 50
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11864_VillaV.pdf
September 21, 2021 Page 217 of 225 Village of Haverstraw Drug Abuse Prevention Council Provider Number: 1779 Ms. Marion E. Breland, Executive Director Telephone - (845)-429-5731 Ext 11 Administrative Office: Haverstraw Center, 50 West Broad Street, Haverstraw, NY 10927
Certificate Number: 211111965 Renewal Effective: 12/01/2018 Anticipated Recert Review: 11/30/2021 Program Location: Village of Haverstraw Youth and Family/Community Center, 50 West Broad Street, Haverstraw, New York 10927 Service Type: Prevention Counseling PRU: 90633 Certified Capacity:
Program Name: Village of Haverstraw Drug Abuse Prevention Counseling
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11965_Villag.pdf
Vocational Instruction Project Community Services, Inc. Provider Number: 325 Ms. Debbian Fletcher-Blake, Chief Executive Officer Telephone - (718)-583-5150 Ext 8650 Administrative Office: 4th Floor, 770 East 176th Street, Bronx, NY 10460
Certificate Number: 201110366 Amendment OASAS Host Effective: 10/15/2019 Anticipated Recert Review: 11/30/2020 Program Location: 1st & 3rd Floors, 770 East 176th Street, , Bronx, New York 10460 Service Type: Integrated Outpatient Services - PC PRU: Certified Capacity:
Program Name:
Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Service Type: Opioid Full Agonist Treatment Program (822) PRU: 670 Certified Capacity: 1000 with Telepractice Designation [with ancillary withdrawal services for up to 100 patients]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10366_Vocati.pdf
Certificate Number: 200511287 Conditional Certificate OASAS Host Effective: 10/15/2019 Anticipated Recert Review: 5/31/2020 Program Location: 4th Floor, 770 East 176th Street, , Bronx, New York 10460 Service Type: Outpatient Service (822) PRU: 6868 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name: Service Type: Integrated Outpatient Services - PC PRU: Certified Capacity:
Program Name:
Service Type: Integrated Outpatient Services - MH PRU: Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11287_Vocati.pdf
September 21, 2021 Page 218 of 225 Certificate Number: 190812045 Renewal Effective: 09/01/2018 Anticipated Recert Review: 8/31/2019 Program Location: 716 Fairmount Place, Bronx, New York 10457 Service Type: Residential Services (820) PRU: 53043 Certified Capacity: 40 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12045_Vocati.pdf
Certificate Number: 200712046 Conditional Certificate Effective: 02/01/2020 Anticipated Recert Review: 7/31/2020 Program Location: 764 East 176th Street, Bronx, New York 10460 Service Type: Residential Services (820) PRU: 53042 Certified Capacity: 80 with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12046_Vocati.pdf
Volunteers of America - Greater New York, Inc. Provider Number: 22790 Ms. Terre Pettitt, President and Chief Executive Telephone - (212)-496-4300 Administrative Office: Officer 340 West 85th Street, New York, NY 10024
Certificate Number: 181210066 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 395 Webster Avenue, New Rochelle, New York 10801 Service Type: Community Residential (819) PRU: 51043 Certified Capacity: 17
Program Name: Crossroads
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10066_Volunt.pdf
Wayne County Community Services Board Provider Number: 70540 Mr. James M. Haitz LCSW-R, Director of Community Telephone - (315)-946-5722 Administrative Office: Services 1519 Nye Road, Lyons, NY 14489
Certificate Number: 221011102 Amendment Effective: 05/15/2020 Anticipated Recert Review: 10/31/2022 Program Location: Rooms 113-120, 122-123A, 148, 149, 149A-149F, 198 & 199, 1st Floor, 1519 Nye Road, , Lyons, New York 14489 Service Type: Outpatient Service (822) PRU: 4168 Certified Capacity: with Telepractice Designation
Program Name: Wayne Substance Abuse Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11102_WayneC.pdf
WellLife Network Inc. Provider Number: 21920 Ms. Sherry Tucker, Chief Executive Officer Telephone - (718)-559-0518 Administrative Office: 142-02 20th Avenue, Flushing, NY 11351
September 21, 2021 Page 219 of 225 Certificate Number: 200912021 Amendment Effective: 07/01/2020 Anticipated Recert Review: 9/30/2020 Program Location: 234 Long Island Avenue, Wyandanch, New York 11798 Service Type: Outpatient Service (822) PRU: 52975 Certified Capacity: with Telepractice and Problem Gambling Designations
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12021_PSCHin.pdf
Certificate Number: 200912022 Amendment Effective: 07/01/2020 Anticipated Recert Review: 9/30/2020 Program Location: 1st Floor, 11 Route 111, , Smithtown, New York 11787 Service Type: Outpatient Service (822) PRU: 52976 Certified Capacity: 0 [with ancillary withdrawal] and Telepractice and Problem Gambling Designations
Program Name: Addiction Recovery Services (ARS)
2nd Floor, 3600 Route 112, Coram, NY 11727 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12022_PSCHIn.pdf
Certificate Number: 200912023 Amendment Effective: 07/01/2020 Anticipated Recert Review: 9/30/2020 Program Location: Room #s 6, 63 and 64, 1st Floor, 55 Horizon Drive, Huntington, New York 11743 Service Type: Outpatient Service (822) PRU: 52977 Certified Capacity: [with ancillary withdrawal] and Telepractice and Problem Gambling Designations
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12023_PSCHIn.pdf
West Midtown Management Group, Inc. Provider Number: 29520 Ms. Lydia Schorr Silverman, President Telephone - (212)-643-8811 Ext 300 Administrative Office: Suite 404, 505 Eighth Avenue, New York, NY 10018
Certificate Number: 240310364 Renewal Effective: 04/01/2021 Anticipated Recert Review: 3/31/2024 Program Location: 5th and 6th Floors - Medical Services Only, 1st and 2nd Floors, 311 West 35th Street, , New York, New York 10001 Service Type: Opioid Treatment Program (822) PRU: 1482 Certified Capacity: 500 with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10364_WestMi.pdf
Certificate Number: 240610365 Renewal Effective: 07/01/2021 Anticipated Recert Review: 6/30/2024 Program Location: 3rd & 4th Floors, Rooms 437-441 & 443, 5th & 6th Floors - Medica, 311 West 35th Street, , New York, New York 10001 Service Type: Opioid Treatment Program (822) PRU: 1483 Certified Capacity: 500 with Telepractice Designation Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10365_WestMi.pdf
September 21, 2021 Page 220 of 225 Certificate Number: 201011288 Conditional Certificate Effective: 07/03/2020 Anticipated Recert Review: 10/31/2020 Program Location: Rooms 417-421, 423-433, 435, 442, 444-446, 4th Floor, 505 Eighth Avenue, , New York, New York 10018 Service Type: Outpatient Service (822) PRU: 51843 Certified Capacity:
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11288_WestMi.pdf
Westchester County Health Care Corporation and HealthAlliance, Inc. as Active Parents HealthAlliance Hospital Provider Number: 83190 Mr. Michael E. Doyle, Executive Director&Chief Telephone - Administrative Office: Medical Officer HealthAlliance Hospital Broadway Campus as Operator, 396 Broadway, Kingston, NY 12401
Certificate Number: 220310591 Renewal Effective: 04/01/2020 Anticipated Recert Review: 3/31/2022 Program Location: 10 Barbarossa Lane, Kingston, New York 12401 Service Type: Outpatient Service (822) PRU: 51244 Certified Capacity:
Program Name:
Service Type: Outpatient Rehabilitation Service (822) PRU: 51923 Certified Capacity:
Program Name:
2905-2 Route 9W, Saugerties, NY 12477 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10591_Westch.pdf
Certificate Number: 230911585 Renewal Effective: 10/01/2020 Anticipated Recert Review: 9/30/2023 Program Location: 2 Barbarossa Lane, Kingston, New York 12401 Service Type: Opioid Treatment Program (822) PRU: 52106 Certified Capacity: 200 Capacity Lifted Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11585_Westch.pdf
Westchester County Health Care Corporation and HealthAlliance, Inc. as Active Parents HealthAlliance Hospital Provider Number: 81410 Mr. Michael Doyle, Interim Executive Director Telephone - (845)-334-2750 Administrative Office: HealthAlliance Hospital Mary's Avenue Campus as Operator, 105 Mary's Avenue, Kingston, NY 12401
Certificate Number: 200311704 Establishment Effective: 04/19/2019 Anticipated Recert Review: 3/31/2020 Program Location: Spellman Building, Room #s 1402, 1403, and 1414, 1st Floor, 105 Mary's Avenue, , Kingston, New York 12401 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 52517 Certified Capacity: 10 - with the use of methadone [up to 4 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]
Program Name: First Step
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11704_Westch.pdf
September 21, 2021 Page 221 of 225 Certificate Number: 230311705 Renewal Effective: 04/01/2020 Anticipated Recert Review: 3/31/2023 Program Location: Spellman Building, Room #s 1402, 1403, and 1414, 1st Floor, 105 Mary's Avenue, , Kingston, New York 12401 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 52518 Certified Capacity: 10 [up to 4 of these beds may be used for the provision of Section 816.6 medically managed withdrawal & stabilization services]
Program Name: First Step
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11705_Westch.pdf
Westchester County Health Care Corporation as Sponsor Mid-Hudson Valley Division of Westchester Medical C Provider Number: 87140 Mr. Michael D. Israel, President and CEO Telephone - (914)-493-7017 Administrative Office: Mid-Hudson Valley Division of Westchester Medical Center as Operator, 100 Woods Road, Valhalla, NY 10595
Certificate Number: 210611841 Renewal Effective: 07/01/2018 Anticipated Recert Review: 6/30/2021 Program Location: Spellman Building-5th Floor, Thorne Building-4th Floor, 241 North Road, Poughkeepsie, New York 12601 Service Type: Inpatient Rehabilitation Service ( 818) PRU: 52760 Certified Capacity: 50
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11841_Westch.pdf
Certificate Number: 200911842 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 9/30/2020 Program Location: 201 South Avenue, Executive Parks, Poughkeepsie, New York 12601 Service Type: Outpatient Service (822) PRU: 52759 Certified Capacity: with Telepractice Designation
Program Name: Turning Point Service Type: Outpatient Rehabilitation Service (822) PRU: 52758 Certified Capacity: with Telepractice Designation
Program Name: Turning Point
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11842_Westch.pdf
Certificate Number: 221111843 Renewal Effective: 12/01/2019 Anticipated Recert Review: 11/30/2022 Program Location: Spellman Building, 4th and 5th Floors, 241 North Road, , Poughkeepsie, New York 12601 Service Type: Medically Managed Withdrawal & Stabilization Services (816.6) PRU: 52761 Certified Capacity: 10
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11843_Westch.pdf
Westfall Associates, Inc. Provider Number: 85059 Mr. Charles Montante, President Telephone - (585)-473-1500 Ext 213 Administrative Office: Building B, Suite 60, 919 Westfall Road, Rochester, NY 14618
September 21, 2021 Page 222 of 225 Certificate Number: 210311105 Amendment Effective: 06/03/2020 Anticipated Recert Review: 3/31/2021 Program Location: Building B, Suite 60, 1st Floor, 919 Westfall Road, Rochester, New York 14618 Service Type: Outpatient Service (822) PRU: 51102 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11105_Westfa.pdf
Whitney M. Young, Jr. Health Center, Inc. Provider Number: 35200 Mr. David Shippee, Chief Executive Officer Telephone - (518)-465-4771 Administrative Office: 920 Lark Drive, Albany, NY 12207
Certificate Number: 220910369 Amendment Effective: 02/18/2021 Anticipated Recert Review: 9/30/2022 Program Location: 1st & 2nd Floors, 10 DeWitt Street, Albany, New York 12207 Service Type: Opioid Treatment Program (822) PRU: 1631 Certified Capacity: 350 Capacity Lifted Program Name:
Service Type: Opioid Medical Maintenance (822) PRU: 53011 Certified Capacity: 0
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10369_Whitne.pdf
Certificate Number: 220110598 Emergency Effective: 09/08/2021 Anticipated Recert Review: 1/5/2022 Program Location: 2nd Floor, 10 DeWitt Street, , Albany, New York 12207 Service Type: Outpatient Service (822) PRU: 50855 Certified Capacity:
Program Name: F.A.C.T.S.
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10598_Whitne.pdf
Wholeview Wellness, LLC Provider Number: 50840 Sarah Church Ph.D., CEO/Executive Director Telephone - (212)-204-8430 Administrative Office: Suite 14A, 14th Floor, 369 Lexington Avenue, New York, NY 10017
Certificate Number: 201012211 Amendment Effective: 11/01/2019 Anticipated Recert Review: 10/31/2020 Program Location: Suite 14A, 14th Floor, 369 Lexington Avenue, , New York, New York 10017 Service Type: Outpatient Service (822) PRU: 53321 Certified Capacity: with Telepractice Designation [with ancillary withdrawal services]
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12211_Wholev.pdf
The William George Agency for Children's Services, Inc. Provider Number: 11710 Ms. Helen Hulings, Executive Director Telephone - (607)-844-6243 Administrative Office: 380 Freeville Road, Freeville, NY 13068
September 21, 2021 Page 223 of 225 Certificate Number: 210811566 Amendment Effective: 05/28/2020 Anticipated Recert Review: 8/31/2021 Program Location: Van Clef Building, 1st, 2nd, & 3rd Floors, 380 Freeville Road, Freeville, New York 13068 Service Type: Outpatient Service (822) PRU: 51772 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11566_Willia.pdf
The Young Men's Christian Association of Long Island, Incorporated Provider Number: 352 Ms. Stacey Spata, Executive Director Telephone - (631)-580-7777 Ext 104 Administrative Office: Suite 6, 1150 Portion Road, Holtsville, NY 11742
Certificate Number: 220511543 Amendment Effective: 10/02/2020 Anticipated Recert Review: 5/31/2022 Program Location: Suite 6, 1150 Portion Road, Holtsville, New York 11742 Service Type: Outpatient Service (822) PRU: 1203 Certified Capacity: with Telepractice Designation
Program Name: Family Services
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11543_YoungM.pdf
Young Men's Christian Association of Greater New York Provider Number: 20860 Ms. Jacqueline Filis, Executive Director Telephone - (718)-948-3232 Administrative Office: 3911 Richmond Avenue, Staten Island, NY 10312
Certificate Number: 211111111 Amendment Effective: 06/10/2020 Anticipated Recert Review: 11/30/2021 Program Location: 3911 Richmond Avenue, Staten Island, New York 10312 Service Type: Outpatient Service (822) PRU: 7209 Certified Capacity: with Telepractice Designation
Program Name: Staten Island YMCA Counseling Service
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11111_YoungM.pdf
Certificate Number: 220511760 Amendment Effective: 06/10/2020 Anticipated Recert Review: 5/31/2022 Program Location: 1st Floor, 285 Vanderbilt Avenue, Staten Island, New York 10304 Service Type: Outpatient Service (822) PRU: 52604 Certified Capacity: with Telepractice Designation
Program Name: Staten Island YMCA Counseling Service
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11760_YoungM.pdf
Certificate Number: 211211970 Amendment Effective: 06/10/2020 Anticipated Recert Review: 12/31/2021 Program Location: 3911 Richmond Avenue, Staten Island, New York 10312 Service Type: Prevention Counseling PRU: 90765 Certified Capacity: with Telepractice Designation
Program Name: Staten Island Branch
Prevention Counseling, 285 Vanderbilt Avenue, Staten Island, NY 10304 Other Service Site(s) At:
September 21, 2021 Page 224 of 225 Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11970_YoungM.pdf
The Young Women's Christian Association of Rochester and Monroe County, N.Y. Provider Number: 10940 Ms. Myra Henry, President and Chief Executive Telephone - (585)-368-2280 Administrative Office: Officer 175 North Clinton Avenue, Rochester, NY 14604
Certificate Number: 181210008 Special ReIssue Effective: 01/01/2018 Anticipated Recert Review: 12/31/2018 Program Location: 175 North Clinton Avenue, Rochester, New York 14604 Service Type: Supportive Living (819) PRU: 51479 Certified Capacity: 29 with Telepractice Designation and up to 46 beds for children Program Name: Steppingstone Supportive Living
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10008_YoungW.pdf
Youth and Family Counseling Agency of Oyster Bay - East Norwich, Inc. Provider Number: 358 Ms. Barbara Rakusin, Executive Director Telephone - (516)-922-6867 Administrative Office: 193A South Street, Oyster Bay, NY 11771
Certificate Number: 201211549 Amendment Effective: 08/25/2020 Anticipated Recert Review: 12/31/2020 Program Location: 193A South Street, , Oyster Bay, New York 11771 Service Type: Outpatient Service (822) PRU: 682 Certified Capacity: with Telepractice Designation
Program Name:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11549_Youtha.pdf
Youth Environmental Services, Inc. d/b/a YES Community Counseling Center Provider Number: 1380 Ms. Jamie E. Bogenshutz, Executive Director Telephone - (516)-799-3203 Administrative Office: 75 Grand Avenue, Massapequa, NY 11758
Certificate Number: 210111229 Amendment Effective: 06/22/2020 Anticipated Recert Review: 1/31/2021 Program Location: 75 Grand Avenue, Massapequa, New York 11758 Service Type: Outpatient Service (822) PRU: 7115 Certified Capacity: with Telepractice Designation
Program Name:
2nd Floor, 152 Center Lane, Levittown, NY 11756 Additional Location(s) At:
Compliance Performance Data: http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11229_YouthE.pdf
September 21, 2021 Page 225 of 225