Certified Chemical Dependence Treatment Providers

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Certified Chemical Dependence Treatment Providers January 31, 2022 As of Division of Quality Assurance and Performance Improvement Bureau of Certification Listing of Janet L. Paloski, Director, Bureau of Certification

Transcript of Certified Chemical Dependence Treatment Providers

Certified Chemical Dependence

Treatment Providers

January 31, 2022As of

Division of Quality Assurance and Performance

Improvement

Bureau of Certification

Listing of

Janet L. Paloski, Director, Bureau of Certification

820 River St., Inc.

Mr. Peter Newkirk, Chief Executive Officer

428 Duane Avenue, Schenectady, NY 12304

Provider Number: 35210

Administrative Office:

Telephone - (518)-377-4228 Ext 202

Certificate Number: 181210136

111-113 Second Avenue, , Troy, New York 12180

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819) 14Service Type:

Program Name:

Certified Capacity:PRU 50863

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10136_820Riv.pdf

Certificate Number: 201110640

134 Franklin Street, Albany, New York 12202

Effective: 08/31/2020 11/30/2020

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)

Eleanor R. Young Memorial Clinic

Service Type:

Program Name:

Certified Capacity:PRU 51423

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10640_820Riv.pdf

Certificate Number: 220111575

551 Bay Road, Queensbury, New York 12804

Effective: 02/01/2020 1/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52105

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11575_820Riv.pdf

Certificate Number: 200612187

13 Crandall Street, , Glens Falls, New York 12801

Effective: 07/22/2019 6/30/2020

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Crandall St. Reintegration

21Service Type:

Program Name:

Certified Capacity:PRU 53339

for men

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12187_820Riv.pdf

A.R.E.B.A. - Casriel, Inc. d/b/a Addiction Care Interventions

Ms. Hawa U. Jalloh LMSW, M-CASAC, CEO

589 Rockaway Avenue, Brooklyn, NY 11212

Provider Number: 11490

Administrative Office:

Telephone - (929)-258-0059 Ext 1002

Certificate Number: 211210643

8th Floor, 255 West 36th Street, , New York, New York 10018

Effective: 01/29/2021 12/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)

Alcoholism Treatment Center

Service Type:

Program Name:

Certified Capacity:PRU 3489

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10643_AREBAC.pdf

January 31, 2022 Page 1 of 227

Certificate Number: 221011439

Pharmacy - 1st Floor, Floors 1-4, 589 Rockaway Avenue, , Brooklyn, New York 11212

Effective: 11/01/2021 10/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 135Service Type:

Program Name:

Certified Capacity:PRU 51656

with Telepractice Designation (w/ability to swing 45 beds between Medically Supervised Inpatient Withdrawal and Inpatient Rehab. services with the use of methadone)

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11439_AREBAC.pdf

Certificate Number: 221011447

Floors 3-5, 589 Rockaway Avenue, , Brooklyn, New York 11212

Effective: 11/01/2021 10/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 46Service Type:

Program Name:

Certified Capacity:PRU 51389

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11447_AREBAC.pdf

AAA Health, Inc.

Ms. Alla Papush, Administrator

1090 Coney Island Ave., Brooklyn, NY 11230

Provider Number: 43710

Administrative Office:

Telephone - (718)-421-2101

Certificate Number: 221011468

2nd Floor, 1090 Coney Island Avenue, Brooklyn, New York 11230

Effective: 10/02/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51953

with Telepractice Designation [with ancillary withdrawal services]

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

Mr. Raul Russi, Chief Executive Officer

141-143 South 3rd Street, Brooklyn, NY 11211

Provider Number: 1522

Administrative Office:

Telephone - (347)-649-3295

Certificate Number: 190210021

834 East 156th Street, Bronx, New York 10455

Effective: 03/12/2018 2/28/2019

Program Location:

Establishment Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 54Service Type:

Program Name:

Certified Capacity:PRU 6093

for men.

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10021_Acacia.pdf

Certificate Number: 190211487

141-143 South Third Street, Brooklyn, New York 11211

Effective: 03/12/2018 2/28/2019

Program Location:

Establishment Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 40Service Type:

Program Name:

Certified Capacity:PRU 51995

for women.

January 31, 2022 Page 2 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11487_Acacia.pdf

Certificate Number: 220211511

141-143 South 3rd Street, Brooklyn, New York 11211

Effective: 08/01/2021 2/28/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6321

with Telepractice Designation

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

Mr Raul Russi, CEO

6th Floor, 300 E. 175th Street, Bronx, NY 10457

Provider Number: 31030

Administrative Office:

Telephone - (347)-649-3036

Certificate Number: 240212196

Basement & Floors 1-8, 435-439 East 119th Street, , New York, New York 10035

Effective: 03/01/2021 2/29/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 72Service Type:

Program Name:

Certified Capacity:PRU 53353

and up to 14 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered

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

Mr. Raul Russi, Chief Executive Officer

966 Prospect Avenue, Bronx, NY 10459

Provider Number: 330

Administrative Office:

Telephone - (347)-649-3036

Certificate Number: 181210107

773 Prospect Avenue, Bronx, New York 10455

Effective: 06/19/2018 12/31/2018

Program Location:

Amendment Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Lorraine Montenegro Women and Children's Facility

38Service Type:

Program Name:

Certified Capacity:PRU 5750

and up to 51 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10107_Acacia.pdf

Certificate Number: 181210553

1st-4th Floors, 1006 East 151st Street, Bronx, New York 10455

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

La Casita III - The Mix

21Service Type:

Program Name:

Certified Capacity:PRU 7258

and up to 44 beds for children

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

Mr. Raul Russi, Chief Executive Officer

6th floor, 300 East 175th Street, Bronx, NY 10457

Provider Number: 1857

Administrative Office:

Telephone - (347)-649-3036

January 31, 2022 Page 3 of 227

Certificate Number: 240112165

[Sleeping Purposes Only for 15 beds at], 4th & 5th Floors, [Services Provided at], 1068 Franklin Avenue, 1064 Franklin Avenue, Bronx, New York 10456

Effective: 02/01/2021 1/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Franklin House

130Service Type:

Program Name:

Certified Capacity:PRU 53297

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

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

Mr. Raul Russi, President & CEO

300 East 175th Street, Bronx, NY 11434

Provider Number: 31340

Administrative Office:

Telephone - 347-649-3037

Certificate Number: 220210090

116-30 Sutphin Boulevard, Jamaica, New York 11434

Effective: 03/19/2021 2/28/2022

Program Location:

Establishment Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 192Service Type:

Program Name:

Certified Capacity:PRU 1256

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.

Mr. Raul Russi, Chief Executive Officer

1776 Clay Avenue, Bronx, NY 10457

Provider Number: 166

Administrative Office:

Telephone - (347)-649-3037 Ext 3036

Certificate Number: 220910351

1st & 3rd Floors, 1776 Clay Avenue, , Bronx, New York 10457

Effective: 09/01/2021 9/30/2022

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Residential Opioid Treatment Program (822) 110Service Type:

Program Name:

Certified Capacity:PRU 1183

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10351_Acacia.pdf

Certificate Number: 241111618

2nd Floor, 1776 Clay Avenue, Bronx, New York 10457

Effective: 12/01/2021 11/30/2024

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 30Service Type:

Program Name:

Certified Capacity:PRU 52099

- 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]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11618_Acacia.pdf

Certificate Number: 240311627

2nd Floor, 1776 Clay Avenue, Bronx, New York 10457

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 23Service Type:

Program Name:

Certified Capacity:PRU 52108

[up to 2 of these beds may be used for the provision of Section 816.7 medically supervised inpatent withdrawal & stabilization services, as needed]

January 31, 2022 Page 4 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11627_Acacia.pdf

Certificate Number: 230411638

Administrative Site: Floors 1 & 2, Services: Floors 3, 4 & 5, 311 East 175th Street, Bronx, New York 10457

Effective: 05/01/2020 4/30/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Rehabilitation Services for Youth (817) 40Service Type:

Program Name:

Certified Capacity:PRU 2

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11638_Acacia.pdf

Certificate Number: 220311834

4th Floor, 175 Central Avenue, Albany, New York 12206

Effective: 09/01/2020 3/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52747

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11834_Acacia.pdf

Certificate Number: 231111848

1st & 2nd Floor, 254 Virginia Street, Buffalo, New York 14201

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52766

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11848_Acacia.pdf

Certificate Number: 210911852

1st & 2nd Floor, 254 Virginia Street, Buffalo, New York 14201

Effective: 11/18/2020 9/30/2021

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Opioid Treatment Program (822) 200Service Type:

Program Name:

Certified Capacity:PRU 52775

with Telepractice Designation

Capacity Lifted

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11852_Acacia.pdf

Certificate Number: 231211856

1st and 4th Floor, 175 Central Avenue, , Albany, New York 12206

Effective: 01/01/2021 12/31/2023

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Opioid Treatment Program (822)

Camino Nuevo

400Service Type:

Program Name:

Certified Capacity:PRU 52785

with Telepractice Designation

Capacity Lifted

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11856_Acacia.pdf

January 31, 2022 Page 5 of 227

Certificate Number: 240311914

1st - 4th Floors, 561 Court Street, , Brooklyn, New York 11231

Effective: 04/27/2021 3/31/2024

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Opioid Treatment Program (822) 850Service Type:

Program Name:

Certified Capacity:PRU 52884

with Telepractice Designation

Capacity Lifted

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11914_Acacia.pdf

Certificate Number: 200811936

1st - 4th Floors, 561 Court Street, Brooklyn, New York 11231

Effective: 07/03/2020 8/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52898

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11936_Acacia.pdf

Certificate Number: 231011964

754 East 151st Street, , Bronx, New York 10455

Effective: 11/01/2020 10/31/2023

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Opioid Treatment Program (822)

Ramon Velez Recovery Center

800Service Type:

Program Name:

Certified Capacity:PRU 52934

with Telepractice Designation

Capacity Lifted

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11946_Acacia.pdf

Certificate Number: 211012043

1st Floor, 754 East 151st Street, Bronx, New York 10455

Effective: 12/03/2020 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Ramon Velez Recovery Center Outpatient Program

Service Type:

Program Name:

Certified Capacity:PRU 53022

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12043_Acacia.pdf

January 31, 2022 Page 6 of 227

Certificate Number: 220812274

1st & 3rd Floors, 1776 Clay Avenue, , Bronx, New York 10457

Effective: 09/01/2021 8/31/2022

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 53582

with Telepractice Designation

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Opioid Treatment Program (822) 550Service Type:

Program Name:

Certified Capacity:PRU 53581

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Certificate Number: 220912290

303 Main Street, Dunkirk, New York 14048

Effective: 12/27/2021 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Safe Point Lighthouse

Service Type:

Program Name:

Certified Capacity:PRU 53599

with Telepractice Designation

Opioid Treatment Program (822) 400Service Type:

Program Name:

Certified Capacity:PRU 53598

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Access: Supports for Living Inc.

Mr. Ronald Colavito, Executive Director

15 Fortune Road West, Middletown, NY 10941

Provider Number: 40310

Administrative Office:

Telephone - (845)-673-7077

Certificate Number: 220112185

Offices: 132, 133, and 134, 16-24 Union Street, , Middletown, New York 10940

Effective: 06/15/2021 1/31/2022

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)

Access: Recovery

Service Type:

Program Name:

Certified Capacity:PRU 53326

with Telepractice Designation

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

Action for a Better Community, Incorporated

Mr. Jerome Underwood, President and CEO

400 West Avenue, Rochester, NY 14611

Provider Number: 37090

Administrative Office:

Telephone - (585)-325-5116

January 31, 2022 Page 7 of 227

Certificate Number: 210710645

Basement and 1st Floors, 33 Chestnut Street, Rochester, New York 14604

Effective: 07/01/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

New Directions

Service Type:

Program Name:

Certified Capacity:PRU 50519

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10645_Action.pdf

The Addiction Center of Broome County, Inc.

Ms. Carmela Pirich, Executive Director

Colonial Plaza, 2nd Floor, 30 West State Street, Binghamton, NY 13901

Provider Number: 36030

Administrative Office:

Telephone - (607)-723-7308 Ext 124

Certificate Number: 231211044

Colonial Plaza, 2nd Floor, 30 West State Street, Binghamton, New York 13901

Effective: 11/12/2021 12/31/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50396

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51980

with Telepractice Designation

Suite A, 103 Leilanis Lane, Norwich, NY 13815

Additional Location(s) At:

Children's Home of Wyoming Conference, 1182 Chenango Street, Binghamton, NY 13901

Additional Location(s) At:

306 Main Street, Endicott, NY 13760

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.

Mr. Keith W. Stack, Executive Director

Administration Building, 90 McCarty Avenue, Albany, NY 12202

Provider Number: 35090

Administrative Office:

Telephone - (518)-465-5470 Ext 214

Certificate Number: 200610128

90 McCarty Avenue, , Albany, New York 12202

Effective: 01/01/2018 6/30/2020

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819)

Albany Citizens Council Supportive Living

38Service Type:

Program Name:

Certified Capacity:PRU 51256

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10128_Addict.pdf

Certificate Number: 230910605

1044 Broadway, Menands, New York 12204

Effective: 10/01/2020 9/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50113

with Telepractice Designation

January 31, 2022 Page 8 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10605_Addict.pdf

Certificate Number: 220212137

90 McCarty Avenue, , Albany, New York 12202

Effective: 06/16/2021 2/28/2022

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Treatment, Recovery, Education and Empowerment (T.R.E.E.) House for Women and Child

16Service Type:

Program Name:

Certified Capacity:PRU 53212

with Telepractice Designation for women and up to 4 beds for children

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12137_Addict.pdf

Certificate Number: 200912207

90 McCarty Avenue, , Albany, New York 12202

Effective: 10/14/2019 9/30/2020

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

McCarty Avenue Men's Stabilization/Rehabilitation

24Service Type:

Program Name:

Certified Capacity:PRU 53459

with Telepractice Designation [for men]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12207_Addict.pdf

Certificate Number: 201112210

79 Glenwood Avenue, , Queensbury, New York 12804

Effective: 02/03/2020 11/30/2020

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Glenwood House

16Service Type:

Program Name:

Certified Capacity:PRU 53545

with Telepractice Designation

and up to 2 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12210_Addict.pdf

Certificate Number: 220112255

111 McCarty Avenue, , Albany, New York 12202

Effective: 02/06/2021 1/31/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Vista House

14Service Type:

Program Name:

Certified Capacity:PRU 53540

for women and up to 6 beds for their children

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12255_Addict.pdf

Addicts Rehabilitation Center Fund, Inc.

Rev. Reginald Williams, President and CEO

1881 Park Avenue, New York, NY 10035

Provider Number: 19

Administrative Office:

Telephone - (646)-783-5331 Ext 217

Certificate Number: 181212079

1881 Park Avenue, New York, New York 10035

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Residential Services (820) 216Service Type:

Program Name:

Certified Capacity:PRU 53111

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

January 31, 2022 Page 9 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12079_Addict.pdf

Advanced Human Services, Inc.

Anna Rikhter M.D., President

112-15 72nd Road, Forest Hills, NY 11375

Provider Number: 42660

Administrative Office:

Telephone - (718)-261-3437

Certificate Number: 181211467

Suite LL1, Basement, 112-15 72nd Road, Forest Hills, New York 11375

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51859

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11467_Advanc.pdf

Certificate Number: 181211763

Basement, 112-15 72nd Road, Forest Hills, New York 11375

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 30Service Type:

Program Name:

Certified Capacity:PRU 52612

with Telepractice Designation [without the use of methadone]

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

Ms. Sharen I. Duke, President/Chief Executive Officer

64 West 35th Street, New York, NY 10001

Provider Number: 48900

Administrative Office:

Telephone - (212)-645-0875 Ext 304

Certificate Number: 231011858

Ground Floor, 2036 Amsterdam Avenue, , New York, New York 10032

Effective: 11/01/2020 10/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

CASA Washington Heights

Service Type:

Program Name:

Certified Capacity:PRU 52799

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11858_AIDSSe.pdf

Albany County Department of Mental Health

Stephen J. Giordano Ph.D., Director

175 Green Street, Albany, NY 12202

Provider Number: 70520

Administrative Office:

Telephone - (518)-447-4567

Certificate Number: 231110648

1st and 2nd Floors, 260 South Pearl Street, Albany, New York 12202

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)

Albany County Alcohol and Substance Abuse Clinic

Service Type:

Program Name:

Certified Capacity:PRU 1865

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10648_Albany.pdf

January 31, 2022 Page 10 of 227

Alcohol and Drug Council of Tompkins County, Inc.

Ms. Angela D. Sullivan, Executive Director

Suite 500, 201 East Green Street, Ithaca, NY 14850

Provider Number: 36070

Administrative Office:

Telephone - (607)-274-6288

Certificate Number: 220410653

Suite 500, 5th Floor, 201 East Green Street, Ithaca, New York 14850

Effective: 10/28/2020 4/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50615

with Telepractice Designation

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

Mr. William W. Bowman, Executive Director

Suite 320, 167 Polk Street, Watertown, NY 13601

Provider Number: 36130

Administrative Office:

Telephone - (315)-788-4660

Certificate Number: 220311991

Administrative Site Only:, Suite 320, 167 Polk Street, Watertown, New York 13601

Effective: 04/01/2020 3/31/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90689

Ohio Elementary School, 1537 Ohio 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 High School, Guidance Office, 36500 Route 26, Carthage, NY 13619

Other Service Site(s) At:

LaFargeville Central School, 20414 Sunrise Avenue, LaFargeville, NY 13656

Other Service Site(s) At:

Watertown High School, Level 3, Balcony Office, 1335 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:

Alexandria Bay Central School District, 2nd Floor, Room 307, 34 Bolton Avenue, Alexandria Bay, NY 13607

Other Service Site(s) At:

Carthage Elementary School, Beaver Lane, Carthage, NY 13619

Other Service Site(s) At:

Case Middle School, 1st Floor, Guidance Office, 1237 Washington Street, Watertown, NY 13601

Other Service Site(s) At:

General Brown Junior-High School, Room 117, 17643 Cemetery Road, Dexter, NY 13634

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

Ms. Janine Stuchin, Executive Director

125 High Rock Avenue, Saratoga Springs, NY 12866

Provider Number: 35250

Administrative Office:

Telephone - (518)-581-1230 Ext 3611

January 31, 2022 Page 11 of 227

Certificate Number: 230211992

Administrative Site Only:, 125 High Rock Avenue, Saratoga Springs, New York 12866

Effective: 11/16/2021 2/28/2023

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90681

South Glens Falls High School, 1st Floor, Guidance Office, 42 Merritt Road, South Glens Falls, NY 12803

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:

Galway Central High School, 1st Floor, Room 109, 5317 Sacandaga Road, Galway, NY 12074

Other Service Site(s) At:

Corinth Middle-High School, 1st Floor, Guidance Suites, 105 Oak Street, Corinth, NY 12822

Other Service Site(s) At:

Oliver W. Winch Middle School, 1st Floor, Guidance Office, 99 Hudson Street, South Glens Falls, NY 12803

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

Ms. Laura Combs, Executive Director

728 State Street, Schenectady, NY 12307

Provider Number: 35060

Administrative Office:

Telephone - (518)-348-7968

Certificate Number: 230210589

1st & 2nd Floors, 728 State Street, Schenectady, New York 12307

Effective: 03/01/2020 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50332

with Telepractice and Problem Gambling Designations

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51966

with Telepractice Designation

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: 231111825

840 State Street, , Schenectady, New York 12307

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52777

with Telepractice Designation with Problem Gambling Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11825_Alcoho.pdf

January 31, 2022 Page 12 of 227

Certificate Number: 220412259

406-408 Summit Avenue, , Schenectady, New York 12307

Effective: 05/03/2021 4/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Purcell House

16Service Type:

Program Name:

Certified Capacity:PRU 53548

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Certificate Number: 220412260

575 Lansing Street, , Schenectady, New York 12303

Effective: 05/03/2021 4/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Georgia S. Perrin House

21Service Type:

Program Name:

Certified Capacity:PRU 53547

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Certificate Number: 220412261

834 Emmett Street, , Schenectady, New York 12307

Effective: 05/03/2021 4/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Margaret T. Smith House

21Service Type:

Program Name:

Certified Capacity:PRU 53549

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Certificate Number: 220412262

70 and 72 Union Avenue, , Schenectady, New York 12308

Effective: 05/03/2021 4/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Bridge Center

22Service Type:

Program Name:

Certified Capacity:PRU 53546

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Allegany Council on Alcoholism and Substance Abuse, Inc.

Mr. William J. Penman, Executive Director

3084 Trapping Brook Road, Wellsville, NY 14895

Provider Number: 38110

Administrative Office:

Telephone - (585)-593-1920 Ext 722

Certificate Number: 191210170

3084 Trapping Brook Road, Wellsville, New York 14895

Effective: 01/02/2018 12/31/2019

Program Location:

Renewal Anticipated Recert Review:

Community Residential (819)

Trapping Brook House

17Service Type:

Program Name:

Certified Capacity:PRU 50178

Supportive Living (819)

Trapping Brook Supportive Living

10Service Type:

Program Name:

Certified Capacity:PRU 51068

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10170_Allega.pdf

January 31, 2022 Page 13 of 227

Certificate Number: 240410658

2956 Airway Road, Wellsville, New York 14895

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50177

with Telepractice Designation

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.

Ms. Angela A. DeSanno, Executive Director

280 Richmond Terrace, Staten Island, NY 10301

Provider Number: 31330

Administrative Office:

Telephone - (917)-816-1929

Certificate Number: 190110089

220 Heberton Avenue , , Staten Island, New York 10302

Effective: 01/01/2018 1/31/2019

Program Location:

Amendment Anticipated Recert Review:

Community Residential (819) 20Service Type:

Program Name:

Certified Capacity:PRU 51041

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10089_Amethy.pdf

Anchor House, Inc.

Ms. Alison King, Executive Director

APT, 1041-47 Bergen Street, Brooklyn, NY 11216

Provider Number: 610

Administrative Office:

Telephone - (718)-771-0760 Ext 101

Certificate Number: 220112128

976 Park Place, , Brooklyn, New York 11213

Effective: 02/01/2021 1/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Residential Services (820) 28Service Type:

Program Name:

Certified Capacity:PRU 53207

with Telepractice Designation (women)

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12128_Anchor.pdf

Certificate Number: 210712129

1041-1047 Bergen Street, , Brooklyn, New York 11216

Effective: 02/01/2021 7/31/2021

Program Location:

Conditional Certificate Anticipated Recert Review:

Residential Services (820) 50Service Type:

Program Name:

Certified Capacity:PRU 53208

(men) with Telepractice

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12129_Anchor.pdf

Argus Community, Inc.

Mr. Richard Weiss, President and Chief Executive Officer

Room 209, 2nd Floor, 760 East 160th Street, Bronx, NY 10456

Provider Number: 10160

Administrative Office:

Telephone - (917)-589-6322

January 31, 2022 Page 14 of 227

Certificate Number: 241210001

402 East 156th Street, Bronx, New York 10455

Effective: 01/01/2022 12/31/2024

Program Location:

Renewal Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Harbor House

59Service Type:

Program Name:

Certified Capacity:PRU 5960

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10001_ArgusC.pdf

Certificate Number: 181210002

3rd Floor, 760 East 160th Street, , Bronx, New York 10456

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 50Service Type:

Program Name:

Certified Capacity:PRU 4200

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10002_ArgusC.pdf

Certificate Number: 231011505

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

Effective: 11/01/2020 10/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

The Elizabeth L. Sturz Outpatient Center

Service Type:

Program Name:

Certified Capacity:PRU 227

with Telepractice Designation

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

2038 Davidson Avenue, Bronx, New York 10453

Effective: 03/01/2021 2/29/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90867

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11781_ArgusC.pdf

Certificate Number: 210511782

507 West 145th Street, New York, New York 10031

Effective: 09/09/2020 5/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52628

with Telepractice Designation

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

Basement-5th Floor, 202-204 Edgecombe Avenue, New York, New York 10030

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Striver House

60Service Type:

Program Name:

Certified Capacity:PRU 52629

January 31, 2022 Page 15 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11783_ArgusC.pdf

Certificate Number: 181212113

114-40 Van Wyck Expressway, South Ozone Park, New York 11420

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Medically Monitored Withdrawal & Stabilization Services (816.9) 36Service Type:

Program Name:

Certified Capacity:PRU 53156

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12113_ArgusC.pdf

Certificate Number: 240112154

2nd, 3rd & 4th Floors, 2015-25 Madison Avenue, , New York, New York 10035

Effective: 02/01/2021 1/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Mary S. Taylor Homeless Outreach Residence

150Service Type:

Program Name:

Certified Capacity:PRU 53274

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12154_ArgusC.pdf

Argus Community, Inc. as Sponsor Create, Inc. as Operator

Mr. Richard Weiss, President/CEO

760 East 160th Street, Bronx, NY 10456

Provider Number: 296

Administrative Office:

Telephone - (718)-401-5700

Certificate Number: 210810743

1st & 2nd Floors, Basement, 73-75 Lenox Avenue, New York, New York 10026

Effective: 09/16/2020 8/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 658

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10743_Create.pdf

Certificate Number: 210812084

121-123 West 111th Street, New York, New York 10026

Effective: 09/16/2020 8/31/2021

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820) 32Service Type:

Program Name:

Certified Capacity:PRU 53116

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

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

Mr. Richard Weiss, President/CEO

760 East 160th Street , Bronx, NY 10456

Provider Number: 80

Administrative Office:

Telephone - (718)-401-5700

Certificate Number: 211010740

9th Floor, 175 Remsen Street, Brooklyn, New York 11201

Effective: 11/20/2020 10/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6285

with Telepractice Designation [with ancillary withdrawal services]

January 31, 2022 Page 16 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10740_Counse.pdf

Certificate Number: 211010741

Suite 300, 175 Fulton Avenue, , Hempstead, New York 11550

Effective: 11/20/2020 10/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 5726

with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10741_Counse.pdf

Certificate Number: 211011478

Kings County District Attorney's Office, 3rd Floor, 210 Joralemon Street, Brooklyn, New York 11201

Effective: 11/20/2020 10/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51993

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11478_Counse.pdf

Certificate Number: 211011601

Suite 501, 5th Floor, 163-18 Jamaica Avenue, Jamaica, New York 11432

Effective: 11/20/2020 10/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52083

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11601_Counse.pdf

Arms Acres, Inc.

Ms. Patrice Wallace-Moore, Chief Executive Officer

75 Seminary Hill Road, Carmel, NY 10512

Provider Number: 32412

Administrative Office:

Telephone - (845)-225-3400 Ext 6131

Certificate Number: 210810097

A, B, and E Wings, Basement & 1st Floor, 75 Seminary Hill Road, , Carmel, New York 10512

Effective: 02/23/2021 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Arms Acres Adult Unit

152Service Type:

Program Name:

Certified Capacity:PRU 50795

with Telepractice Designation [with the use of methadone] [Up to 39 of these beds may be used for the provision of Part 816.7 medically supervised inpatient withdrawal & stabilization service as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10097_ArmsAc.pdf

Certificate Number: 210810665

7th Floor, 80-02 Kew Gardens Road, Kew Gardens, New York 11415

Effective: 05/29/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7248

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10665_ArmsAc.pdf

January 31, 2022 Page 17 of 227

Certificate Number: 240510666

1st Floor, 21 Old Route 6, , Carmel, New York 10512

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Arms Acres Outpatient Program

Service Type:

Program Name:

Certified Capacity:PRU 51591

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10666_ArmsAc.pdf

Certificate Number: 210811488

1st Floor, F Wing, 75 Seminary Hill Road, Carmel, New York 10512

Effective: 02/23/2021 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 39Service Type:

Program Name:

Certified Capacity:PRU 50798

with Telepractice Designation [with the use of methadone] [Up to 39 of these beds may be used for the provision of Part 818 inpatient rehabilitation services as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11488_ArmsAc.pdf

Certificate Number: 240611619

1st Floor, 3584 Jerome Avenue, Bronx, New York 10467

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52100

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11619_ArmsAc.pdf

Certificate Number: 210912074

1st Floor, 21 Old Route 6, , Carmel, New York 10512

Effective: 10/16/2019 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Full Agonist Treatment Program (822)

Arms Acres Opioid Treatment Program

200Service Type:

Program Name:

Certified Capacity:PRU 53070

with Telepractice Designation

Capacity Lifted

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

Mr. Jonathan Lawrence, President and CEO

600 Roe Avenue, Elmira, NY 14905

Provider Number: 82200

Administrative Office:

Telephone - (607)-737-4233

Certificate Number: 200412197

6th Floor, 555 St. Joseph's Boulevard, , Elmira, New York 14901

Effective: 05/30/2019 4/30/2020

Program Location:

Establishment Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

New Dawn Southern Tier Addiction Rehabilitation Services (STARS)

20Service Type:

Program Name:

Certified Capacity:PRU 53357

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12197_ArnotH.pdf

January 31, 2022 Page 18 of 227

Backstretch Employee Service Team of New York, Inc.

Mr. Paul Ruchames LCSW, Executive Director

Belmont Park, Gate 6, Cottage 28B, 2150 Hempstead Turnpike, Elmont, NY 11003

Provider Number: 47560

Administrative Office:

Telephone - (516)-488-3434 Ext 103

Certificate Number: 200911723

Cottage 28B, Belmont Park, Gate 6, 2150 Hempstead Turnpike, Elmont, New York 11003

Effective: 01/01/2018 9/30/2020

Program Location:

Special ReIssue Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52547

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11723_Backst.pdf

Baden Street Settlement of Rochester, Inc.

Mr. Ron Thomas, Executive Director

152 Baden Street, Rochester, NY 14605

Provider Number: 16220

Administrative Office:

Telephone - (585)-445-6718

Certificate Number: 190910671

1st and 2nd Floor, 585 Joseph Avenue, Rochester, New York 14605

Effective: 01/01/2018 9/30/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 130

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10671_BadenS.pdf

Behavioral Enhancement and Substance Abuse Medicine Treatment, PLLC

Tomrul Tuzel M.D., CEO/Medical Director

Suite 17, 770 Grand Boulevard, Deer Park, NY 11729

Provider Number: 48360

Administrative Office:

Telephone - (631)-392-4357

Certificate Number: 220311797

Suite 17, 770 Grand Boulevard, , Deer Park, New York 11729

Effective: 05/05/2021 3/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52688

with Telepractice Designation

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

Certificate Number: 220912277

998 Old Country Road, , Plainview, New York 11803

Effective: 11/23/2021 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

BEST-Plainview

Service Type:

Program Name:

Certified Capacity:PRU 53587

with Telepractice Designation

January 31, 2022 Page 19 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12277_Behavi

Behavioral Health Services North, Inc.

Mr. Mark A. Lukens, President/CEO

Suite 218, 22 U.S. Oval, Plattsburgh, NY 12903

Provider Number: 12050

Administrative Office:

Telephone - (518)-324-2177

Certificate Number: 211012236

25 Willowbrook Road, , Queensbury, New York 12804

Effective: 08/10/2021 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

The Center for Recovery

Service Type:

Program Name:

Certified Capacity:PRU 53508

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12236_Behavi.pdf

Certificate Number: 211012237

Basement & 1st Floor, 340 Main Street, , Hudson Falls, New York 12839

Effective: 08/10/2021 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

The Center for Recovery

Service Type:

Program Name:

Certified Capacity:PRU 53509

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12237_Behavi.pdf

Certificate Number: 211212251

1st and 2nd Floors, 75 Oak Street, , Plattsburgh, New York 12901

Effective: 01/08/2021 12/31/2021

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Twin Oaks

20Service Type:

Program Name:

Certified Capacity:PRU 53530

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

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

Ms. Maria Mendez, Executive VP/COO

7 Debevoise Street, Brooklyn, NY 11206

Provider Number: 44840

Administrative Office:

Telephone - (212)-837-2013

Certificate Number: 210811567

2nd Floor, 7 Debevoise Street, Brooklyn, New York 11206

Effective: 05/15/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52021

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11567_BGRSer.pdf

Bikur Cholim, Inc.

Mr. Aron Reiner, Executive Director

25 Robert Pitt Drive, Monsey, NY 10952

Provider Number: 20470

Administrative Office:

Telephone - (845)-425-7877 Ext 123

January 31, 2022 Page 20 of 227

Certificate Number: 240312018

Suite 101, 1st Floor, 25 Robert Pitt Drive, Monsey, New York 10952

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52968

[with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12018_BikurC.pdf

Bleuler Psychotherapy Center, Inc.

Steven Helfand Psy.D, Executive Director

3rd Floor, 104-70 Queens Boulevard, Forest Hills, NY 11375

Provider Number: 15300

Administrative Office:

Telephone - (718)-275-6010

Certificate Number: 210211700

3rd Floor, 104-70 Queens Boulevard, , Forest Hills, New York 11375

Effective: 09/01/2020 2/28/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)

Bleuler Chemical Dependency Recovery Services

Service Type:

Program Name:

Certified Capacity:PRU 52521

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11700_Bleule.pdf

Bliss-Poston The Second Wind, Inc.

Mr. John Bliss, Executive Director

Suite 403, 928 Broadway, New York, NY 10010

Provider Number: 1823

Administrative Office:

Telephone - (212)-481-1055

Certificate Number: 220110675

Suite 403, 4th Floor, 928 Broadway, New York, New York 10010

Effective: 08/31/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 5111

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10675_BlissP.pdf

BMMG Health Company LLC d/b/a Voyage Health

Mr. Brian McMahon, Executive Director

Suite 1B, 251 Oakland Avenue, Port Jefferson, NY 11777

Provider Number: 51670

Administrative Office:

Telephone - (631)-310-3418

Certificate Number: 221012291

Suite 1B, 251 Oakland Avenue, , Port Jefferson, New York 11777

Effective: 11/15/2021 10/31/2022

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)

Voyage Health

Service Type:

Program Name:

Certified Capacity:PRU 53543

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12291_BMMGHe.pdf

Bon Secours Community Hospital

Mary Leahy M.D., Chief Executive Officer

160 East Main Street, Port Jervis, NY 12771

Provider Number: 81780

Administrative Office:

Telephone - (845)-368-5000

January 31, 2022 Page 21 of 227

Certificate Number: 210910242

4th Floor, 160 East Main Street, Port Jervis, New York 12771

Effective: 12/05/2018 9/7/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6)

New Directions

7Service Type:

Program Name:

Certified Capacity:PRU 51051

[with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10242_BonSec.pdf

Certificate Number: 210911363

4th Floor, 160 East Main Street, Port Jervis, New York 12771

Effective: 12/05/2018 9/7/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

New Directions

15Service Type:

Program Name:

Certified Capacity:PRU 51824

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11363_BonSec.pdf

Bowery Residents' Committee, Inc.

Mr. Muzzy Rosenblatt, CEO/President

12th Floor, 131 West 25th Street, New York, NY 10001

Provider Number: 50490

Administrative Office:

Telephone - (212)-803-5700

Certificate Number: 221110622

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

Effective: 07/31/2020 11/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50012

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10622_Bowery.pdf

Certificate Number: 230912117

127 West 25th Street, New York, New York 10001

Effective: 10/01/2021 9/30/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 32Service Type:

Program Name:

Certified Capacity:PRU 53160

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12117_Bowery.pdf

Boys and Girls Harbor, Inc.

Thomas Howard Ph.D., Executive Director

1 East 104th Street, New York, NY 10029

Provider Number: 31050

Administrative Office:

Telephone - (212)-427-2244 Ext 582

Certificate Number: 200211967

4th, 5th & 7th Floor, 1 East 104th Street, New York, New York 10029

Effective: 01/01/2018 2/29/2020

Program Location:

Special ReIssue Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90776

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11967_Boysan.pdf

January 31, 2022 Page 22 of 227

Bridge Back to Life Center, Inc.

Mr. Gary A. Butchen, Chief Executive Officer

Lower Level, 4271 Hempstead Turnpike, Bethpage, NY 11714

Provider Number: 2050

Administrative Office:

Telephone - (516)-520-6600

Certificate Number: 201110677

Basement, 1688 Victory Boulevard, Staten Island, New York 10314

Effective: 04/22/2020 11/30/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6094

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10677_Bridge.pdf

Certificate Number: 211110678

Basement, 4271 Hempstead Turnpike, Bethpage, New York 11714

Effective: 04/22/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7139

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10678_Bridge.pdf

Certificate Number: 210111254

3rd Floor, 3044 Coney Island Avenue, Brooklyn, New York 11235

Effective: 04/22/2020 1/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7356

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11254_Bridge.pdf

Certificate Number: 210111343

10th Floor, 175 Remsen Street, Brooklyn, New York 11201

Effective: 04/22/2020 1/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7180

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11343_Bridge.pdf

The Bridge, Inc.

Ms. Susan Wiviott, Chief Executive Officer

248 West 108th Street, New York, NY 10025

Provider Number: 18130

Administrative Office:

Telephone - (212)-663-3318

Certificate Number: 210511428

Cellar, 1st, 2nd, 3rd, 4th & 5th Floors, 248-250 West 108th Street, , New York , New York 10025

Effective: 10/07/2020 5/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

The Center for Wellness and Change

Service Type:

Program Name:

Certified Capacity:PRU 7371

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11428_Bridge.pdf

January 31, 2022 Page 23 of 227

Bridging Access to Care, Inc.

Ms. Nadine Akinyemi, Executive Director

2261 Church Avenue, Brooklyn, NY 11226

Provider Number: 31640

Administrative Office:

Telephone - (347)-505-5115

Certificate Number: 220111255

2261 Church Avenue, Brooklyn, New York 11226

Effective: 05/28/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7275

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11255_Bridgi.pdf

BronxCare Health System

Mr. Miguel A. Fuentes Jr., President, Chief Executive Officer

Executive Suite, Main Floor, 1276 Fulton Avenue, Bronx, NY 10456

Provider Number: 85190

Administrative Office:

Telephone - (718)-901-8800

Certificate Number: 220310288

Life Recovery Center, 5th Floor, 1285 Fulton Avenue, Bronx, New York 10456

Effective: 04/01/2019 3/31/2022

Program Location:

Renewal Anticipated Recert Review:

Community Residential (819)

BronxCare Life Recovery Community Residence

22Service Type:

Program Name:

Certified Capacity:PRU 50036

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10288_BronxC.pdf

Certificate Number: 210310445

1276 Fulton Avenue, Bronx, New York 10456

Effective: 07/10/2020 3/31/2021

Program Location:

Conditional Certificate Anticipated Recert Review:

Opioid Treatment Program (822)

BronxCare Opioid Treatment Program

600Service Type:

Program Name:

Certified Capacity:PRU 309

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10445_BronxC.pdf

Certificate Number: 240511409

4th Floor, 1285 Fulton Avenue, Bronx, New York 10456

Effective: 05/21/2021 5/21/2024

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

BronxCare Addictions Rehabilitation Program

25Service Type:

Program Name:

Certified Capacity:PRU 51116

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11409_BronxC.pdf

Certificate Number: 220711845

1st and 2nd Floors, 1285 Fulton Avenue, Bronx, New York 10456

Effective: 08/01/2021 7/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:OASAS Host

Integrated Outpatient Services - PCService Type:

Program Name:

Certified Capacity:PRU

Outpatient Service (822)

BronxCare Chemical Dependence Outpatient Treatment Program

Service Type:

Program Name:

Certified Capacity:PRU 52764

with Telepractice Designation

January 31, 2022 Page 24 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11845_BronxC.pdf

Certificate Number: 240511846

Life Recovery Center, 3rd Floor, 1285 Fulton Avenue, Bronx, New York 10456

Effective: 05/21/2021 5/21/2024

Program Location:

Renewal Anticipated Recert Review:Deemed

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

BronxCare Addictions Detoxification Program

20Service Type:

Program Name:

Certified Capacity:PRU 52763

[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.]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11846_BronxC.pdf

Brookhaven Memorial Hospital Medical Center, Inc. d/b/a Long Island Community Hospital

Mr. Richard T. Margulis, President and Chief Executive Officer

101 Hospital Road, Patchogue, NY 11772

Provider Number: 85340

Administrative Office:

Telephone - (631)-654-7177

Certificate Number: 210810679

550 Montauk Highway, , Shirley, New York 11967

Effective: 09/29/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Memorial Hospital Medical Center Outpatient Chemical Dependency Services

Service Type:

Program Name:

Certified Capacity:PRU 50101

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10679_Brookh.pdf

Brooklyn Center for Psychotherapy, Inc.

Ms. Kerri Kopelowitz, Executive Director

300 Flatbush Avenue, Brooklyn, NY 11217

Provider Number: 32130

Administrative Office:

Telephone - 718-622-2000

Certificate Number: 230510680

500/500A /502A Atlantic Avenue, Brooklyn, New York 11217

Effective: 06/01/2021 5/31/2023

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Outpatient Service (822)

New Directions

0Service Type:

Program Name:

Certified Capacity:PRU 50337

with Telepractice Designation

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10680_Brookl.pdf

The Brooklyn Hospital Center

Gary Terrinoni M.D., President and CEO

121 DeKalb Avenue, Brooklyn, NY 11201

Provider Number: 27480

Administrative Office:

Telephone - (718)-250-8005

January 31, 2022 Page 25 of 227

Certificate Number: 220710510

B Building, Downtown Campus, 9th Floor, 121 DeKalb Avenue, Brooklyn, New York 11201

Effective: 04/09/2020 7/31/2022

Program Location:

Amendment Anticipated Recert Review:

Medically Managed Withdrawal & Stabilization Services (816.6) 6Service Type:

Program Name:

Certified Capacity:PRU 8033

[with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10510_Brookl.pdf

Brooks-TLC Hospital System, Inc.

Ms. Mary E. LaRowe, President and CEO

529 Central Avenue, Dunkirk, NY 14048

Provider Number: 49960

Administrative Office:

Telephone - (716)-363-7207

Certificate Number: 210512141

33 North Main Street, Cassadaga, New York 14718

Effective: 06/10/2020 5/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53215

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12141_Brooks.pdf

Certificate Number: 210412142

7020 Erie Road, Derby, New York 14047

Effective: 06/10/2020 4/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53229

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12142_Brooks.pdf

Brownsville Community Development Corporation

Mr. Harvey Lawrence, Chief Executive Officer/President

592 Rockaway Avenue, Brooklyn, NY 11212

Provider Number: 45250

Administrative Office:

Telephone - (718)-345-5000 Ext 1123

Certificate Number: 211211588

657-663 East 98th Street, Brooklyn, New York 11236

Effective: 01/01/2019 12/31/2021

Program Location:

Renewal Anticipated Recert Review:

Community Residential (819) 21Service Type:

Program Name:

Certified Capacity:PRU 51330

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11588_Browns.pdf

Brylin Hospitals, Inc.

Mr. Eric D. Pleskow, Chief Executive Officer

1263 Delaware Avenue, Buffalo, NY 14209

Provider Number: 81490

Administrative Office:

Telephone - (716)-886-8200 Ext 7601

January 31, 2022 Page 26 of 227

Certificate Number: 240310687

531 Farber Lakes Drive, Williamsville, New York 14221

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50709

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10687_Brylin.pdf

Buffalo Beacon Corporation d/b/a Beacon Center

Ms. Jacqueline West, Chief Executive Officer

3354 Sheridan Drive, Amherst, NY 14226

Provider Number: 32812

Administrative Office:

Telephone - (716)-602-9525

Certificate Number: 220910688

Suite 105, 295 Main Street, Buffalo, New York 14203

Effective: 01/03/2020 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51708

with Telepractice Designtation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10688_Buffal.pdf

Certificate Number: 230910689

3354 Sheridan Drive, Amherst, New York 14226

Effective: 10/01/2020 9/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51048

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10689_Buffal.pdf

Certificate Number: 221210692

36 East Avenue, Lockport, New York 14094

Effective: 01/03/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51818

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10692_Buffal.pdf

Certificate Number: 230211256

Room 106, 417 3rd Street, Niagara Falls, New York 14301

Effective: 03/01/2020 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7330

With Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11256_Buffal.pdf

January 31, 2022 Page 27 of 227

Certificate Number: 240311631

1st and 2nd Floors, 210 South Main Street, Herkimer, New York 13350

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Beacon Center

Service Type:

Program Name:

Certified Capacity:PRU 52112

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11631_Buffal.pdf

Certificate Number: 210211754

1508 Genesee Street, Utica, New York 13502

Effective: 11/20/2020 2/28/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52584

with Telepractice Designation

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

303 West Liberty Street, Rome, New York 13440

Effective: 10/01/2020 9/30/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 150Service Type:

Program Name:

Certified Capacity:PRU 53021

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12042_Buffal.pdf

Certificate Number: 240112140

201 King Street, Herkimer, New York 13350

Effective: 02/01/2021 1/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Albert O. Nichols House

15Service Type:

Program Name:

Certified Capacity:PRU 53239

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12140_Buffal.pdf

Certificate Number: 210612231

1st Floor, 1508 Genesee Street, , Utica, New York 13502

Effective: 09/04/2020 6/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 150Service Type:

Program Name:

Certified Capacity:PRU 53501

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12231_Buffal.pdf

C.C.M.S.

Mr. Emory X. Brooks, President and Chief Executive Officer

2nd Floor, 25 Elm Place, Brooklyn, NY 11201

Provider Number: 19430

Administrative Office:

Telephone - (718)-802-0666

January 31, 2022 Page 28 of 227

Certificate Number: 211110695

1st Floor, 810 Classon Avenue, , Brooklyn, New York 11238

Effective: 12/01/2019 11/30/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7277

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.

Ms. Joanne M. Oplustil, President and CEO

2nd Floor, 1720 Church Avenue, Brooklyn, NY 11226

Provider Number: 31600

Administrative Office:

Telephone - 718-287-2600

Certificate Number: 240411979

Administrative Site Only:, 2nd Floor, 1720 Church Avenue, Brooklyn, New York 11226

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90812

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.

Mr. Luke J. Nasta, Executive Director

Suite 4, 4442 Arthur Kill Road, Staten Island, NY 10309

Provider Number: 12030

Administrative Office:

Telephone - (718)-356-5100

Certificate Number: 210810696

1268 Forest Avenue, Staten Island, New York 10302

Effective: 07/10/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 1687

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10696_Camelo.pdf

Certificate Number: 210410697

Basement, 175-15 Rockaway Boulevard, Jamaica, New York 11434

Effective: 07/10/2020 4/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 5594

with Telepractice Designation

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:

Basement, 521 West 49th Street, New York, NY 10019

Additional Location(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10697_Camelo.pdf

January 31, 2022 Page 29 of 227

Certificate Number: 240812147

Seaview Hospital, 460H Brielle Avenue, Staten Island, New York 10314

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 45Service Type:

Program Name:

Certified Capacity:PRU 53213

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12147_Camelo.pdf

Certificate Number: 220612267

273 Heberton Avenue, , Staten Island, New York 10302

Effective: 07/01/2021 6/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820) 24Service Type:

Program Name:

Certified Capacity:PRU 53541

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12267_Camelo

Care Counseling Center, LLC

Mr. Faruk Khwaja, Executive Director

214 West 116th Street, New York, NY 10026

Provider Number: 48850

Administrative Office:

Telephone - (212)-602-1400

Certificate Number: 210811861

214-216 West 116th Street, New York, New York 10026

Effective: 07/01/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52795

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11861_CareCo.pdf

Carnegie Hill Institute, Inc.

Ms. Anna Marie Karkus, Executive Director

Apt. 1BC, 116 East 92nd Street, New York, NY 10128

Provider Number: 549

Administrative Office:

Telephone - (305)-772-2289

Certificate Number: 220510383

Basement & 1st Floor, 116 East 92nd Street, New York, New York 10128

Effective: 06/05/2020 5/31/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 200Service Type:

Program Name:

Certified Capacity:PRU 1472

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10383_Carneg.pdf

Certificate Number: 220311257

Basement & 1st Floor, 116 East 92nd Street, New York, New York 10128

Effective: 04/01/2019 3/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7335

January 31, 2022 Page 30 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11257_Carneg.pdf

CASA-Trinity, Inc.

Ms. Ann Domingos, CEO

4612 Millennium Drive, Geneseo, NY 14454

Provider Number: 37130

Administrative Office:

Telephone - (585)-991-5012

Certificate Number: 211010847

Wing B, 4612 Millennium Drive, Geneseo, New York 14454

Effective: 11/01/2019 10/31/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50184

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10847_CASA-T.pdf

Certificate Number: 211210848

45 Maple Street, Dansville, New York 14437

Effective: 01/01/2020 12/31/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

CASA-Trinity, Inc.

0Service Type:

Program Name:

Certified Capacity:PRU 50186

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10848_Counci.pdf

Certificate Number: 231111692

2nd Floor, 150 Lake Street, Elmira, New York 14901

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

d/b/a Trinity of Chemung County

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52231

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11692_CASATr.pdf

Certificate Number: 200112156

45 Maple Street, , Dansville, New York 14437

Effective: 01/02/2020 1/31/2020

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820) 26Service Type:

Program Name:

Certified Capacity:PRU 53307

with telepractice designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12156_CASATr.pdf

Certificate Number: 240512201

1st Floor, 86 River Street, , Hornell, New York 14843

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53387

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12201_CASA-T.pdf

January 31, 2022 Page 31 of 227

Certificate Number: 210212213

7309 Seneca Road, Hornell, New York 14843

Effective: 03/12/2020 2/28/2021

Program Location:

Establishment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 4Service Type:

Program Name:

Certified Capacity:PRU 53386

[up to 3 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12213_CASA-T.pdf

Certificate Number: 230612228

7309 Seneca Road, Hornell, New York 14843

Effective: 07/01/2021 6/30/2023

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 26Service Type:

Program Name:

Certified Capacity:PRU 53491

[up to 6 of these beds may be used for the provision of Part 816.7 medically supervised withdrawal and stabilization serivces, as needed

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12228_CASA-T.pdf

Catholic Charities Neighborhood Services, Inc.

Ms Patricia Bowles, Senior Vice President/Chief Program Officer

14th Floor, 191 Joralemon Street, Brooklyn, NY 11201

Provider Number: 40490

Administrative Office:

Telephone - (718)-722-6146

Certificate Number: 220210600

1st Floor, 1623 Flatbush Avenue, , Brooklyn, New York 11210

Effective: 10/25/2021 2/22/2022

Program Location:

Emergency Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51149

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10600_Cathol.pdf

Catholic Charities of Fulton and Montgomery Counties

Ms. Mary A. Carpenter, Executive Director

Suite 100, 55 East Main Street, Johnstown, NY 12095

Provider Number: 12340

Administrative Office:

Telephone - (518)-762-8313 Ext 226

Certificate Number: 230112003

Suite 100, 55 East Main Street, Johnstown, New York 12095

Effective: 02/01/2020 1/31/2023

Program Location:

Renewal Anticipated Recert Review:

Prevention Counseling

Catholic Charities of Fulton County

Service Type:

Program Name:

Certified Capacity:PRU 90645

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

January 31, 2022 Page 32 of 227

Certificate Number: 221212005

Building 2, 1 Kimball Street, Amsterdam, New York 12010

Effective: 01/01/2020 12/31/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90659

East High School, North Wing, 25 School District Road, Canajoharie, NY 13317

Other Service Site(s) At:

Fonda Fultonville Elementary School, 112 Old Johnstown Road, Fonda, NY 12068

Other Service Site(s) At:

East Hill School, 25 School District Road, Canajoharie, NY 13317

Other Service Site(s) At:

Fort Plain Jr./Sr. High School, 1 West Street, Fort Plains, NY 13339

Other Service Site(s) At:

Fonda Fultonville Central School, Cemetery Road, Fonda, NY 12068

Other Service Site(s) At:

Fonda Fultonville Middle School, 112 Old Johnstown Road, Fonda, NY 12068

Other Service Site(s) At:

Fonda Fultonville High School, 112 Old Johnstown Road, Fonda, NY 12068

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:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12005_Cathol.pdf

Catholic Charities of Herkimer County

Ms. Maureen Petrie, Executive Director

61 West St, Ilion, NY 13357

Provider Number: 17000

Administrative Office:

Telephone - (315)-894-9917 Ext 222

Certificate Number: 241012002

Room 7, Basement Level, 61 West Street, Ilion, New York 13357

Effective: 11/01/2021 10/31/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90649

Dolgeville Central School, Office Adj. to Room 12, 38 Slawson Street, Dolgeville, NY 13329

Other Service Site(s) At:

Herkimer Central School District, 1st Floor, Office, 801 W. German Street, Herkimer, NY 13350

Other Service Site(s) At:

Herkimer BOCES, 352 Gros Blvd Street, Herkimer, NY 13350

Other Service Site(s) At:

Poland Central School, 1st Floor, Guidance Office, 74 Cold Brook Street, Poland, NY 13431

Other Service Site(s) At:

Mt. Markham Central School District , 500 Fairground Road , West Winfield, NY 13491

Other Service Site(s) At:

Town of Webb School, 2nd Floor Office, 3002 Main Street, Old Forge, NY 13420

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12002_Cathol.pdf

January 31, 2022 Page 33 of 227

Catholic Charities of Orange, Sullivan & Ulster

Ms. Shannon Kelly, Deputy CEO

27 Matthews Street, Goshen, NY 10924

Provider Number: 45020

Administrative Office:

Telephone - (845)-294-5124 Ext 1002

Certificate Number: 210311577

101 Carpenter Place, Monroe, New York 10950

Effective: 04/01/2019 3/31/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Monroe Clinic OP

Service Type:

Program Name:

Certified Capacity:PRU 52117

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11577_Cathol.pdf

Certificate Number: 210311578

305 North Street, Middletown, New York 10940

Effective: 08/19/2019 3/31/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Middletown Clinic OP

Service Type:

Program Name:

Certified Capacity:PRU 52116

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11578_Cathol.pdf

Certificate Number: 230411579

1st Floor, 27 Matthews Street, Goshen, New York 10924

Effective: 08/31/2021 4/30/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Goshen Clinic OP

Service Type:

Program Name:

Certified Capacity:PRU 52115

with Telepractice Designation

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

Ground Floor, 280 Broadway, , Newburgh, New York 12550

Effective: 04/01/2019 3/31/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Newburgh Clinic OP

Service Type:

Program Name:

Certified Capacity:PRU 52122

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11580_Cathol.pdf

Certificate Number: 211111688

1st Floor, 17-19 Sussex Street, Port Jervis, New York 12771

Effective: 08/31/2021 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Port Jervis Clinic OP

Service Type:

Program Name:

Certified Capacity:PRU 52217

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11688_Cathol.pdf

January 31, 2022 Page 34 of 227

Certificate Number: 230411720

8 Scofield Street, Walden, New York 12586

Effective: 08/31/2021 4/30/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Walden Clinic OP

Service Type:

Program Name:

Certified Capacity:PRU 52539

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11720_Cathol.pdf

Certificate Number: 210111866

396 Broadway, Monticello, New York 12701

Effective: 02/01/2020 1/31/2021

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)

Monticello Clinic OP/Day Rehab OP-R

Service Type:

Program Name:

Certified Capacity:PRU 52808

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52812

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11866_Cathol.pdf

Certificate Number: 230311869

1st & 2nd Floors, 17 Hamilton Avenue, Monticello, New York 12701

Effective: 08/31/2021 3/31/2023

Program Location:

Amendment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

Monticello MSW IP

6Service Type:

Program Name:

Certified Capacity:PRU 52806

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11869_Cathol.pdf

Certificate Number: 220912288

1st & 2nd Floors , 17 Hamilton Avenue, , Monticello, New York 12701

Effective: 10/11/2021 9/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Monticello Stabilization

10Service Type:

Program Name:

Certified Capacity:PRU 53517

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Certificate Number: 220912289

1st & 2nd Floors, 17 Hamilton Avenue and 16 Jones Street, , Monticello, New York 12701

Effective: 10/11/2021 9/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Monticello Rehabilitation and Reintegration

37Service Type:

Program Name:

Certified Capacity:PRU 53518

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12289_Cathol.pdf

Catholic Charities of the Diocese of Rochester d/b/a Catholic Charities Steuben/Livingston

Tabitha J. Brewster Ph.D., Chief Executive Director

23 Liberty Street, Bath, NY 14810

Provider Number: 44050

Administrative Office:

Telephone - (607)-776-8085

January 31, 2022 Page 35 of 227

Certificate Number: 230212053

Administrative Site Only:, 23 Liberty Street, , Bath, New York 14810

Effective: 11/01/2021 2/28/2023

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU

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:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12053_Cathol.pdf

Certificate Number: 240212188

Basement, 1st & 2nd Floors, 130 Rumsey Street, , Bath, New York 14810

Effective: 03/01/2021 2/29/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 18Service Type:

Program Name:

Certified Capacity:PRU 53344

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12188_Cathol.pdf

Certificate Number: 240312189

Administrative Site:, 23 Liberty Street, , Bath, New York 14810

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 18Service Type:

Program Name:

Certified Capacity:PRU 53343

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

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

Ms. Marlene Bessette, President and Chief Executive Officer

Floor #s 1 - 7, 79 North Clinton Avenue, Rochester, NY 14604

Provider Number: 20250

Administrative Office:

Telephone - (585)-546-7220 Ext 7153

Certificate Number: 240810700

Floor #s 1 - 7, 79 North Clinton Avenue, Rochester, New York 14604

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 1191

with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51933

with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10700_Cathol.pdf

January 31, 2022 Page 36 of 227

Certificate Number: 181211673

1st & 2nd Flrs, Basement, 380 Barrington Street, Rochester, New York 14607

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Barrington Street Community Residence

11Service Type:

Program Name:

Certified Capacity:PRU 52207

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11673_Cathol.pdf

Certificate Number: 181211674

1st & 2nd Flrs, Basement, 184 Alexander Street, Rochester, New York 14607

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Alexander Street Community Residence

16Service Type:

Program Name:

Certified Capacity:PRU 52208

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11674_Cathol.pdf

Certificate Number: 181211675

3rd Floor, 79 North Clinton Avenue, Rochester, New York 14604

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819)

Restart Supportive Living Program

24Service Type:

Program Name:

Certified Capacity:PRU 52210

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11675_Cathol.pdf

Certificate Number: 190611676

24 Jones Avenue, , Rochester, New York 14608

Effective: 03/01/2019 6/30/2019

Program Location:

Amendment Anticipated Recert Review:

Community Residential (819)

Jones Avenue Community Residence

24Service Type:

Program Name:

Certified Capacity:PRU 52209

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11676_Cathol.pdf

Certificate Number: 201111995

Administrative Site Only:, 79 N. Clinton Avenue, Rochester, New York 14604

Effective: 12/01/2018 11/30/2020

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90651

Hilton High School, 400 East Avenue, Hilton, NY 14468

Other Service Site(s) At:

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:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11995_Cathol.pdf

January 31, 2022 Page 37 of 227

Certificate Number: 181212060

997 St. Paul Street, Rochester, New York 14605

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Residential Services (820)

Liberty Manor

17Service Type:

Program Name:

Certified Capacity:PRU 53040

[2 of these beds may be used temporarily for adults] - with Telepractice Designation

and up to 5 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12060_Cathol.pdf

Certificate Number: 190812061

Basement, 1st & 2nd Floors, 55 Troup Street, Rochester, New York 14608

Effective: 01/24/2019 8/31/2019

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Freedom House

30Service Type:

Program Name:

Certified Capacity:PRU 53038

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12061_Cathol.pdf

Certificate Number: 211212062

(Counseling), 407 East Union Street, 110 South Clinton Street, Basement, 1st & 2nd Floors, (Residence), , Newark, New York 14513

Effective: 12/20/2021 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Hannick Hall

20Service Type:

Program Name:

Certified Capacity:PRU 53039

[2 of these beds may be used temporarily for adults] - with Telepractice Designation

and up to 7 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12062_Cathol.pdf

Catholic Charities of the Diocese of Rockville Centre

Ms. Laura A. Cassell, Chief Executive Officer/Executive Director

90 Cherry Lane, Hicksville, NY 11801

Provider Number: 20580

Administrative Office:

Telephone - (516)-733-7000

Certificate Number: 201010586

St. Rosalie's Church, Lower Level, 31 East Montauk Highway, , Hampton Bays, New York 11946

Effective: 09/21/2020 10/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Hampton Bays Outpatient Clince

Service Type:

Program Name:

Certified Capacity:PRU 50125

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10586_Cathol.pdf

Certificate Number: 240912049

30-C Carlough Road, Bohemia, New York 11716

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Talbot House

35Service Type:

Program Name:

Certified Capacity:PRU 53205

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

January 31, 2022 Page 38 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12049_Cathol.pdf

Catholic Charities of the Diocese of Syracuse

Ms. Marie Walsh, Executive Director

10 Kennedy Parkway, Cortland, NY 13045

Provider Number: 50760

Administrative Office:

Telephone - (607)-756-5992 Ext 202

Certificate Number: 190810208

29 Charles Street, Cortland, New York 13045

Effective: 05/17/2019 8/31/2019

Program Location:

Amendment Anticipated Recert Review:

Supportive Living (819)

Recovery Apartment Program

9Service Type:

Program Name:

Certified Capacity:PRU 51514

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10208_Cathol.pdf

Certificate Number: 181211655

29 Charles Street, Cortland, New York 13045

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Catholic Charities The Charles Street Residence

14Service Type:

Program Name:

Certified Capacity:PRU 51308

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11655_Cathol.pdf

Catholic Charities of the Roman Catholic Diocese of Syracuse, N.Y. d/b/a Catholic Charities of Utica/Rome

Mr. Jack Callaghan, Executive Director

Administrative Office, 1408 Genesee Street, Utica, NY 13502

Provider Number: 20560

Administrative Office:

Telephone - (315)-724-2158

Certificate Number: 181210056

1616 Genesee Street, Utica, New York 13502

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 16Service Type:

Program Name:

Certified Capacity:PRU 51784

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10056_Cathol.pdf

Certificate Number: 200710057

Basement, 1st & 2nd Flrs, 1505 Whitesboro Street, Utica, New York 13502

Effective: 01/01/2018 7/31/2020

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 16Service Type:

Program Name:

Certified Capacity:PRU 50681

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

Mr. Charles Urlaub, Chief Executive Officer

Mount St. Mary's Hospital of Niagara Falls as Operator, 5300 Military Road, Lewiston, NY 14092

Provider Number: 81790

Administrative Office:

Telephone - (716)-298-2017

January 31, 2022 Page 39 of 227

Certificate Number: 210211890

3rd and 4th Floors, 5300 Military Road, Lewiston, New York 14092

Effective: 10/03/2018 2/23/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

Clearview Treatment Services

69Service Type:

Program Name:

Certified Capacity:PRU 52859

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11890_Cathol.pdf

Cazenovia Recovery Systems, Inc.

Ms. Suzanne Bissonette J.D., Chief Executive Officer

Suite 417, 2495 Main Street, Buffalo, NY 14214

Provider Number: 38170

Administrative Office:

Telephone - (716)-852-4331 Ext 203

Certificate Number: 181211860

Administrative Site Only:, 2671 Main Street, , Buffalo, New York 14214

Effective: 01/01/2018 12/31/2018

Program Location:

Amendment Anticipated Recert Review:

Supportive Living (819) 138Service Type:

Program Name:

Certified Capacity:PRU 50806

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11860_Cazeno.pdf

Certificate Number: 190511961

Administrative Site Only:, 1522 Main Street, , Niagara Falls, New York 14305

Effective: 01/08/2018 5/31/2019

Program Location:

Amendment Anticipated Recert Review:

Supportive Living (819) 15Service Type:

Program Name:

Certified Capacity:PRU 52932

and up to 3 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11961_Cazeno.pdf

Certificate Number: 240112050

1st & 2nd Floors, 486 North Legion Drive, , Buffalo, New York 14210

Effective: 02/01/2021 1/31/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Cazenovia Manor by Caz Recovery

23Service Type:

Program Name:

Certified Capacity:PRU 53077

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12050_Cazeno.pdf

Certificate Number: 181212051

5586 Niagara Street Extension, Lockport, New York 14094

Effective: 01/01/2018 12/31/2018

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Madonna House by Caz Recovery

16Service Type:

Program Name:

Certified Capacity:PRU 53076

with Telepractice Designation

and up to 12 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12051_Cazeno.pdf

January 31, 2022 Page 40 of 227

Certificate Number: 220912122

923 Sycamore Street, , Buffalo, New York 14212

Effective: 10/01/2021 9/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Unity House by Caz Recovery

24Service Type:

Program Name:

Certified Capacity:PRU 53574

[for men]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12122_Cazeno.pdf

Certificate Number: 240112124

1st Floor, 9126 Sandrock Road & 9136 Sandrock Road, , Eden, New York 14057

Effective: 02/01/2021 1/31/2024

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Turning Point House by Caz Recovery

21Service Type:

Program Name:

Certified Capacity:PRU 53246

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12124_Cazeno.pdf

Certificate Number: 220912282

200 Albany Street, , Buffalo, New York 14213

Effective: 10/01/2021 9/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Casa Di Vita by Caz Recovery

19Service Type:

Program Name:

Certified Capacity:PRU 53573

[for women]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12282_Cazeno.pdf

Certificate Number: 220912283

7397 Lake Road, , Appleton, New York 14008

Effective: 10/01/2021 9/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Somerset House by Caz Recovery

17Service Type:

Program Name:

Certified Capacity:PRU 53571

[for women]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12283_Cazeno.pdf

Certificate Number: 220912284

Basement, 1st, 2nd & 3rd Floors, 431 Memorial Parkway, , Niagara Falls, New York 14303

Effective: 10/01/2021 9/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Sundram Manor by Caz Recovery

17Service Type:

Program Name:

Certified Capacity:PRU 53572

[for men]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12284_Cazeno.pdf

Center for Community Alternatives, Inc.

Mr. David Condliffe, Executive Director

Suite 701, 25 Chapel Street, Brooklyn, NY 11201

Provider Number: 2136

Administrative Office:

Telephone - (315)-546-4365

January 31, 2022 Page 41 of 227

Certificate Number: 231210704

7th Floor, 25 Chapel Street, Brooklyn, New York 11201

Effective: 01/01/2021 12/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Crossroads

Service Type:

Program Name:

Certified Capacity:PRU 6520

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10704_Center.pdf

Center for Comprehensive Health Practice, Inc.

Ms. Ann M. Mendelsohn, Chief Executive Officer

12th Floor, 1900 2nd Avenue, New York, NY 10029

Provider Number: 10030

Administrative Office:

Telephone - (212)-360-7481

Certificate Number: 211110705

12th Floor, 1900 2nd Avenue, , New York, New York 10029

Effective: 06/26/2021 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7053

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10705_Center.pdf

Certificate Number: 210311670

12th Floor, 1900 2nd Avenue, , New York, New York 10029

Effective: 07/10/2020 3/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 444Service Type:

Program Name:

Certified Capacity:PRU 3553

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11670_Center.pdf

The Center for Rapid Recovery, Inc.

Renee D. Charles Ph.D., President & Chief Executive Officer

312 Greenwich Street, Hempstead, NY 11550

Provider Number: 26730

Administrative Office:

Telephone - (516)-292-6449

Certificate Number: 230711050

1st Floor, 312 Greenwich Street, Hempstead, New York 11550

Effective: 08/01/2021 7/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 7252

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11050_Center.pdf

The Center for Youth Services, Inc.

Elaine Spaull Ph.D., Executive Director

905 Monroe Avenue, Rochester, NY 14620

Provider Number: 37050

Administrative Office:

Telephone - (585)-473-2464

January 31, 2022 Page 42 of 227

Certificate Number: 220311987

1st Floor, 901-905 Monroe Avenue, Rochester, New York 14620

Effective: 04/01/2019 3/31/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90698

School of the Arts (SOTA), 3rd Floor, Room 432, 45 Prince Street, Rochester, NY 14607

Other Service Site(s) At:

James Monroe High School, 2nd Floor, Room 202, 164 Alexander 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:

East High School, 1st Floor, Room B-130, 1801 East Main Street, Rochester, NY 14609

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.

Mr. Jeffrey Friedman, Chief Executive Officer

950 South Oyster Bay Road, Hicksville, NY 11801

Provider Number: 50710

Administrative Office:

Telephone - (516)-822-6111

Certificate Number: 230910706

950 South Oyster Bay Road, Hicksville, New York 11801

Effective: 10/01/2020 9/30/2023

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 771

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10706_Centra.pdf

Central Park Recovery, LLC

Ms Nicole Intervallo, Chief Executive Officer

2176 Central Park Avenue, Yonkers, NY 10710

Provider Number: 51520

Administrative Office:

Telephone - (914)-619-5242

Certificate Number: 220612241

2176 Central Park Avenue, , Yonkers, New York 10710

Effective: 07/19/2021 6/30/2022

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53514

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53564

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Champlain Valley Family Center for Drug Treatment and Youth Services, Inc.

Ms. Constance Wille, Chief Executive Director

20 Ampersand Drive, Plattsburgh, NY 12901

Provider Number: 1065

Administrative Office:

Telephone - (518)-561-8480

January 31, 2022 Page 43 of 227

Certificate Number: 220110710

20 Ampersand Drive, Plattsburgh, New York 12901

Effective: 05/11/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 3101

with Telepractice Designation

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: 240712015

20 Ampersand Drive, Plattsburgh, New York 12901

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90620

Beekmantown Central School District, Counseling Offices, 1st & 2nd Floors, 37 Eagle Way, West Chazy, NY 12992

Other Service Site(s) At:

AuSable Valley Central Middle School, Main Floor, Guidance Office - Rm 132, 1273 Route 9N, Keeseville, NY 12924

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:

Northern Adirondack Central School District, Room BC-2, 5586 State Route 11, Ellenburg Depot, NY 12935

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:

Plattsburgh High School, Health Office, Room 406, One Clifford Drive, Plattsburgh, NY 12901

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12015_Champl.pdf

Certificate Number: 240412138

516 Norrisville Road , Schuyler Falls, New York 12985

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Champlain Valley Family Center Recovery Campus

16Service Type:

Program Name:

Certified Capacity:PRU 53247

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12138_Champl.pdf

Charles Evans Center, Inc.

Mr. James R. Dolan Jr., Executive Director

857 South Oyster Bay Road, Bethpage, NY 11714

Provider Number: 49140

Administrative Office:

Telephone - (516)-622-8888 Ext 225

January 31, 2022 Page 44 of 227

Certificate Number: 201112218

113 Glen Cove Avenue, , Glen Cove, New York 11542

Effective: 10/20/2020 11/30/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Charles Evans Center at Glen Cove

Service Type:

Program Name:

Certified Capacity:PRU 53342

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12218_Charle.pdf

Chautauqua County Department of Mental Health

Carmelo Hernandez M.S., M.B.A., Director of Community Mental Hygiene Services

Hall R Clothier Bldg., 1st Floor, 2 Academy Street, Mayville, NY 14757

Provider Number: 70360

Administrative Office:

Telephone - (716)-753-4104

Certificate Number: 240710711

City Hall, 5th Floor, 200 East Third Street, Jamestown, New York 14701

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50702

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10711_Chauta.pdf

Certificate Number: 240710712

2nd Floor, 319 Central Avenue, Dunkirk, New York 14048

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50703

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10712_Chauta.pdf

Chenango County Community Services Board

Ms. Ruth Roberts, Director

County Office Building, Suite 42, 5 Court Street, Norwich, NY 13815

Provider Number: 70010

Administrative Office:

Telephone - (607)-337-1604

Certificate Number: 231010713

Suite 42, 5 Court Street, Norwich, New York 13815

Effective: 11/01/2020 10/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Chenango County Behavioral Health Services

Service Type:

Program Name:

Certified Capacity:PRU 472

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10713_Chenan.pdf

Child & Family Guidance Center Addiction Services, Inc.

Mr. Christopher Dennehy, Executive Director

106 Vineyard Avenue, Highland, NY 12528

Provider Number: 16230

Administrative Office:

Telephone - (845)-594-4239

January 31, 2022 Page 45 of 227

Certificate Number: 221010715

106 Vineyard Avenue and 102 Vineyard Avenue (1st & 2nd Floors), Highland, New York 12528

Effective: 12/02/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51463

with Telepractice Designation

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

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

Effective: 11/01/2019 10/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52156

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11653_ChildF.pdf

The Child Center of NY, Inc.

Ms. Traci Donnelly, CEO and Executive Director

6th Floor, 118-35 Queens Boulevard, Forest Hills, NY 11375

Provider Number: 18000

Administrative Office:

Telephone - (718)-651-7770

Certificate Number: 220510953

2nd Floor, 163-18 Jamaica Avenue, , Jamaica, New York 11432

Effective: 01/12/2022 5/31/2022

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)

Jamaica Family Center-CD-OP

Service Type:

Program Name:

Certified Capacity:PRU 6308

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10953_ChildC.pdf

Certificate Number: 220511277

140-15B Sanford Avenue, Flushing, New York 11355

Effective: 06/01/2019 5/31/2022

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51686

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

Ms. Phoebe C. Boyer, President and CEO

117 W 124th Street, New York, NY 10027

Provider Number: 20660

Administrative Office:

Telephone - (212)-949-4800

January 31, 2022 Page 46 of 227

Certificate Number: 201111973

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

Effective: 04/22/2020 11/30/2020

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90763

Opportunity Charter School, 4th Floor, 240 West 113th Street, New York, NY 10026

Other Service Site(s) At:

Lexington Academy PS 72, 408B, 131 East 104th Street, New York, NY 10029

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.

Jeremy Kohomban Ph.D., President/CEO

One Echo Hill, Dobbs Ferry, NY 10522

Provider Number: 14690

Administrative Office:

Telephone - (914)-693-0600 Ext 1201

Certificate Number: 230412143

1 Echo Hills, , Dobbs Ferry, New York 10522

Effective: 05/01/2021 4/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53242

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12143_Childr.pdf

Citizen Advocates, Inc. d/b/a North Star Industries

Mr. James Button, CEO

125 Finney Boulevard, P.O. Box 608, Malone, NY 12953

Provider Number: 40410

Administrative Office:

Telephone - (518)-483-1251

Certificate Number: 211010717

31 Sixth Street, Malone, New York 12953

Effective: 07/01/2018 10/31/2021

Program Location:

Amendment/Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 5048

[with ancillary withdrawal services]

7 Stetson Road, Tupper Lake, NY 12986

Additional Location(s) At:

143 White Birch Road, Indian Lake, NY 12842

Additional Location(s) At:

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:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10717_Citize.pdf

January 31, 2022 Page 47 of 227

Certificate Number: 210312004

31 Sixth Street, Malone, New York 12953

Effective: 04/01/2019 3/31/2021

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90719

St. Regis Falls Central School, Room B121A, 92 North Main Street, St. Regis Falls, NY 12980

Other Service Site(s) At:

Malone High School (Franklin Academy), Room 118, 42 Huskie Lane, Malone, NY 12953

Other Service Site(s) At:

43 River Street, Chateaugay, NY 12920

Other Service Site(s) At:

Tupper Lake Central School, Rooms A207 & B107, 25 Chaney Avenue, Tupper Lake, NY 12986

Other Service Site(s) At:

Malone Middle School, Room 419, 15 Francis Street, 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

Mr. Frank Williams Jr., Executive Director

11 Amherst Place, White Plains, NY 10601

Provider Number: 29210

Administrative Office:

Telephone - (914)-422-1378 Ext 6702

Certificate Number: 240912027

11 Amherst Place, White Plains, New York 10601

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90664

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

Dustin Riccio, President, Eastern Region

2 Coulter Road, Clifton Springs, NY 14432

Provider Number: 85490

Administrative Office:

Telephone - (315)-332-2298

Certificate Number: 230211879

Woodbury Building, 3rd Floor, 2 Coulter Road, Clifton Springs, New York 14432

Effective: 03/01/2021 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

The Inpatient Addiction Recovery Program

30Service Type:

Program Name:

Certified Capacity:PRU 52847

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11879_Clifto.pdf

January 31, 2022 Page 48 of 227

Certificate Number: 211211880

1st Floor, 2 Coulter Road, , Clifton Springs, New York 14432

Effective: 09/10/2020 12/31/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52846

with Telepractice Designation

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

Ms. Richelle Gregory, Director of Community Services

Suite 1500, 130 Arizona Avenue, Plattsburgh, NY 12903

Provider Number: 70020

Administrative Office:

Telephone - (518)-565-4060

Certificate Number: 211110723

130 Arizona Avenue, Plattsburgh, New York 12903

Effective: 10/13/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)

Clinton County Addiction Services

Service Type:

Program Name:

Certified Capacity:PRU 50757

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.

Mr. L. Nathan Hare, CEO/President

Suite 150, 45 Jewett Avenue, Buffalo, NY 14214

Provider Number: 46

Administrative Office:

Telephone - (716)-881-5150

Certificate Number: 220410379

1st Floor, 1237 Main Street, Buffalo, New York 14209

Effective: 05/01/2020 4/30/2022

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822)

Drug Abuse Research and Treatment (DART) Program

430Service Type:

Program Name:

Certified Capacity:PRU 13

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10379_Commun.pdf

The Community Place of Greater Rochester, Inc.

Mr. Scott Benjamin, Chief Executive Officer

57 Central Park, Rochester, NY 14605

Provider Number: 42880

Administrative Office:

Telephone - 585-327-7200 Ext 112

Certificate Number: 240511803

Level 1 & Level Intermediate, 145 Parsells Avenue, Rochester, New York 14609

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90849

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

January 31, 2022 Page 49 of 227

Concern for Independent Living, Inc.

Mr. Ralph Fasano, Executive Director

312 Expressway Drive South, Medford, NY 11763

Provider Number: 16390

Administrative Office:

Telephone - (631)-758-0474

Certificate Number: 191011769

72 Riviera Drive, Selden, New York 11784

Effective: 01/01/2018 10/31/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819) 3Service Type:

Program Name:

Certified Capacity:PRU 52590

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11769_Concer.pdf

Concourse Medical Center, Inc.

Ms. Ana Matos, Acting Executive Director

880 Morris Avenue, Bronx, NY 10451

Provider Number: 43050

Administrative Office:

Telephone - (718)-665-9340 Ext 118

Certificate Number: 210911295

880 Morris Avenue, , Bronx, New York 10451

Effective: 10/01/2020 9/30/2021

Program Location:

Conditional Certificate Anticipated Recert Review:

Opioid Treatment Program (822) 600Service Type:

Program Name:

Certified Capacity:PRU 829

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11295_Concou.pdf

Confidential Help for Alcohol and Drugs, Inc.

Mr. Kevin D. Hares, Executive Director

75 Genesee Street, Auburn, NY 13021

Provider Number: 36200

Administrative Office:

Telephone - (315)-253-9786

Certificate Number: 231110727

The Piccolo Building, 1st Floor, 75 Genesee Street, , Auburn, New York 13021

Effective: 06/11/2021 10/31/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

CHAD

Service Type:

Program Name:

Certified Capacity:PRU 50846

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10727_Confid.pdf

Certificate Number: 230112019

The Piccolo Building, 1st Floor, 75 Genesee Street, , Auburn, New York 13021

Effective: 02/01/2020 1/31/2023

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90690

Millard Fillmore Elementary School, South Main Street, Moravia, NY 13118

Other Service Site(s) At:

Southern Cayuga Central School, 2384 Route 34B, Aurora, NY 13026

Other Service Site(s) At:

Moravia Central School, South Main Street, Moravia, NY 13118

Other Service Site(s) At:

January 31, 2022 Page 50 of 227

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:

Cato-Meridian Central School, 2851 State Route 370, Cato, NY 13033

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12019_Confid.pdf

Conifer Park, Inc.

Ms. Patricia A. Wilcox, CEO

79 Glenridge Road, Glenville, NY 12302

Provider Number: 14770

Administrative Office:

Telephone - (518)-952-8323

Certificate Number: 201010018

A1, A2, B2, C2, D1, D2, D3 & S2, 79 Glenridge Road, Glenville, New York 12302

Effective: 10/22/2021 2/19/2022

Program Location:

Emergency Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 171Service Type:

Program Name:

Certified Capacity:PRU 50849

with Telepractice Designation [with the use of methadone] [using up to 28 beds for swing beds to Section 816.7 medically supervised inpatient withdrawal & stabilization service in A1 Rooms only]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10018_Conife.pdf

Certificate Number: 210810729

Basement,, 1st Floor and 2nd Floor, 55 Elm Street, , Glens Falls, New York 12801

Effective: 10/16/2019 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Conifer Park Outpatient Clinic

Service Type:

Program Name:

Certified Capacity:PRU 51101

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10729_Conife.pdf

Certificate Number: 210810730

2nd Floor, 600 Franklin Street, , Schenectady, New York 12305

Effective: 10/16/2019 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Outpatient Clinic

0Service Type:

Program Name:

Certified Capacity:PRU 51828

with Telepractice Designation [with ancillary withdrawal services at the additional location site at 79 Glenridge Road, Glenville only]

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

550-556 South Clinton Avenue, , Rochester, New York 14620

Effective: 10/16/2019 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Outpatient Clinic

0Service Type:

Program Name:

Certified Capacity:PRU 5265

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10731_Conife.pdf

January 31, 2022 Page 51 of 227

Certificate Number: 211110732

Unit 1, 80 Sharron Avenue, , Plattsburgh, New York 12901

Effective: 10/16/2019 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 51575

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10732_Conife.pdf

Certificate Number: 211210733

Building 2, Left Wing, Suite #s 4, 5 and 6, 526 Old Liverpool Road, Liverpool, New York 13088

Effective: 10/16/2019 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Victoria Square

Service Type:

Program Name:

Certified Capacity:PRU 51568

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10733_Conife.pdf

Certificate Number: 210510738

1st - 3rd Floors, 2435 Sixth Avenue, Troy, New York 12180

Effective: 10/16/2019 5/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 51826

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10738_Conife.pdf

Certificate Number: 240711437

C1, 79 Glenridge Road, Glenville, New York 12302

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 34Service Type:

Program Name:

Certified Capacity:PRU 3814

with Telepractice Designation [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11437_Conife.pdf

Certificate Number: 211011809

Unit 1, 80 Sharron Avenue, , Plattsburgh, New York 12901

Effective: 10/16/2019 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Full Agonist Treatment Program (822) 100Service Type:

Program Name:

Certified Capacity:PRU 52696

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11809_Conife.pdf

Certificate Number: 211211944

Suite #s 4, 5 and 6, 526 Old Liverpool Road, , Liverpool, New York 13088

Effective: 05/01/2020 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Full Agonist Treatment Program (822) 200Service Type:

Program Name:

Certified Capacity:PRU 52959

with Telepractice Designation

Capacity Lifted

January 31, 2022 Page 52 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11944_Conife.pdf

Certificate Number: 210812065

1st, 2nd & 3rd Floors, 2435 Sixth Avenue, , Troy, New York 12180

Effective: 10/16/2019 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Full Agonist Treatment Program (822) 75Service Type:

Program Name:

Certified Capacity:PRU 53060

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12065_Conife.pdf

Certificate Number: 220112135

Part 822 - OTP, 2nd Floor, 600 Franklin Street, , Schenectady, New York 12305

Effective: 08/18/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 200Service Type:

Program Name:

Certified Capacity:PRU 53233

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12135_Conife.pdf

Contact Community Services, Inc.

Ms. Patricia R. Leone, Executive Director

6311 Court Street Road, East Syracuse, NY 13057

Provider Number: 12480

Administrative Office:

Telephone - (315)-251-1400 Ext 117

Certificate Number: 220411756

Administrative Site Only:, 6311 Court Street Road, East Syracuse, New York 13057

Effective: 05/01/2019 4/30/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90646

Institute of Technology at Syracuse Central, 258 E. Adams Street, Syracuse, NY 13202

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:

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:

Henninger High School, 600 Robinson Street, Syracuse, NY 13206

Other Service Site(s) At:

North Syracuse Junior High School, 5353 Taft Road, North Syracuse, NY 13212

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11756_Contac.pdf

COPAY, INC.

Ms. Maria E. Cuadra, Executive Director/CEO

2nd Floor, 21 North Station Plaza, Great Neck, NY 11021

Provider Number: 145

Administrative Office:

Telephone - (516)-466-2509

January 31, 2022 Page 53 of 227

Certificate Number: 210310739

2nd Floor, 21 North Station Plaza, Great Neck, New York 11021

Effective: 05/29/2020 3/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 497

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10739_COPAYI.pdf

Cornerstone Family Healthcare

Ms. Linda Muller, President and CEO

Suite 10, 2570 US Highway 9W, Cornwall, NY 12518

Provider Number: 45040

Administrative Office:

Telephone - (845)-220-3112

Certificate Number: 240611595

1st Floor, 3 Commercial Place, , Newburgh, New York 12550

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Center For Recovery

Service Type:

Program Name:

Certified Capacity:PRU 52069

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52071

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11595_Corner.pdf

Certificate Number: 240311642

1st Floor, 3 Commercial Place, , Newburgh, New York 12550

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822)

Center for Recovery Methadone Maintenance Treatment Program

450Service Type:

Program Name:

Certified Capacity:PRU 52138

Capacity Lifted

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.

Ms. Regina Hernandez, Agency Site Director

Room 28, 807 Route 52, Fishkill, NY 12524

Provider Number: 34340

Administrative Office:

Telephone - (845)-745-6426

Certificate Number: 240111592

Room 28, 807 Route 52, Fishkill, New York 12524

Effective: 04/16/2021 1/31/2024

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90674

with Telepractice Designation

Wappingers Central School District - John Jay High School, 2012 Route 52, Hopewell Junction, NY 12533

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:

Hyde Park Central Schools - FDR High School, 154 South Cross Road, Hyde Park, NY 12538

Other Service Site(s) At:

January 31, 2022 Page 54 of 227

Dover Union Free School District - Dover Jr. - Sr. High School, 2368 Route 22, Dover Plains, NY 12522

Other Service Site(s) At:

Red Hook High School, 103 West Market Street, Red Hook, NY 12571

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:

Wappingers Central School District - Van Wyck Jr., 10 Hillside Lake Road, Wappinger Falls, NY 12590

Other Service Site(s) At:

Linden Avenue Middle School, 66 West Market Street, Red Hook, NY 12501

Other Service Site(s) At:

Haviland Middle School, 23 Haviland Road, Hyde Park, NY 12538

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.

Mr. Michael Prutsman, Executive Director

201 South Union Street, P.O. Box 567, Olean, NY 14760

Provider Number: 38160

Administrative Office:

Telephone - (716)-373-4303 Ext 513

Certificate Number: 181210172

207 South Union Street, Olean, New York 14760

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819) 16Service Type:

Program Name:

Certified Capacity:PRU 51754

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10172_Counci.pdf

Certificate Number: 190310173

1351 Olean Portville Road, Weston Mills, New York 14788

Effective: 01/01/2018 3/31/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Weston Manor

16Service Type:

Program Name:

Certified Capacity:PRU 51055

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10173_Counci.pdf

Certificate Number: 190910702

2nd Floor, 201 South Union Street, Olean, New York 14760

Effective: 06/05/2019 9/30/2019

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50770

with Telepractice Designation

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:

Community Healthy Alliance, 1 School Street, Gowanda, NY 14070

Additional Location(s) At:

January 31, 2022 Page 55 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10702_Counci.pdf

Certificate Number: 210612232

1355 Olean Portville Road, , Weston Mills, New York 14788

Effective: 08/17/2020 6/30/2021

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Willow House 820 Residential

20Service Type:

Program Name:

Certified Capacity:PRU 53506

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

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

Mr. Timothy VanDamme, Executive Director

620 W Washington St, Geneva, NY 14456

Provider Number: 37250

Administrative Office:

Telephone - (315)-789-0310

Certificate Number: 230312010

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

Effective: 04/01/2020 3/31/2023

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90707

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90704

Watkins Glen Elementary School, 1st Floor, Room #447, 612 S. Decatur Street, Watkins Glen, NY 14891

Other Service Site(s) At:

Watkins Glen High School, 301 12th Street, Watkins Glen, NY 14891

Other Service Site(s) At:

Dundee Central School, 55 Water Street, Dundee, NY 14837

Other Service Site(s) At:

Penn Yan Elementary School, 3 School Drive, Penn Yan, NY 14527

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

Mr. Joseph Chelales, VP of Compliance

141 8th Street , Brentwood, NY 11717

Provider Number: 48620

Administrative Office:

Telephone - (646)-285-4035

Certificate Number: 230611810

2000 Maple Hill Street, Yorktown Heights, New York 10598

Effective: 07/01/2021 6/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52721

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11810_Counse.pdf

January 31, 2022 Page 56 of 227

Certificate Number: 220512266

141 8th Street, , Brentwood, New York 11717

Effective: 06/15/2021 5/31/2022

Program Location:

Establishment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

Sunrise Detox Brentwood

20Service Type:

Program Name:

Certified Capacity:PRU 53557

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Counseling Services of New York LLC

Mr. Brian Ketay, Operations Manager

Suite 1B, 911 Walton Avenue, Bronx, NY 10452

Provider Number: 44640

Administrative Office:

Telephone - (713)-818-6210

Certificate Number: 211011554

Suite 1B, 911 Walton Avenue, Bronx, New York 10452

Effective: 07/03/2020 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52002

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11554_Counse.pdf

Credo Community Center for the Treatment of Addictions, Inc.

Mr. John C. Wilson, Executive Director

595 West Main Street, Watertown, NY 13601

Provider Number: 41270

Administrative Office:

Telephone - (315)-788-1530 Ext 105

Certificate Number: 210910744

595 West Main Street, , Watertown, New York 13601

Effective: 10/16/2019 9/30/2021

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 4986

with Telepractice Designation

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU 4986

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

Certificate Number: 181211239

1st and 2nd Floors, 1130 State Street, Watertown, New York 13601

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Patricia Pond Hinckley Women's Residence

15Service Type:

Program Name:

Certified Capacity:PRU 7295

with Telepractice Designation

and up to 5 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11239_CredoC.pdf

January 31, 2022 Page 57 of 227

Certificate Number: 190111299

417 Washington Street, Watertown, New York 13601

Effective: 01/01/2018 1/31/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 16Service Type:

Program Name:

Certified Capacity:PRU 50262

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11299_CredoC.pdf

Certificate Number: 181211360

Basement,, 1st & 2nd Floors, 138 Winthrop Street, Watertown, New York 13601

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 15Service Type:

Program Name:

Certified Capacity:PRU 1589

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11360_CredoC.pdf

Certificate Number: 241011632

Jenkins Road, 24180 County Route 16, Evans Mills, New York 13637

Effective: 11/01/2021 10/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Rehabilitation Services for Youth (817) 14Service Type:

Program Name:

Certified Capacity:PRU 1347

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11632_CredoC.pdf

Certificate Number: 230112028

595 West Main Street, , Watertown, New York 13601

Effective: 02/01/2020 1/31/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 100Service Type:

Program Name:

Certified Capacity:PRU 52964

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12028_CredoC.pdf

Crouse Health Hospital, Inc.

Ms. Kimberly Boynton, Chief Executive Officer

736 Irving Avenue, Syracuse, NY 13210

Provider Number: 85010

Administrative Office:

Telephone - (315)-470-7376

Certificate Number: 230910439

2nd Floor, 2775 Erie Boulevard East, , Syracuse, New York 13224

Effective: 06/18/2021 9/30/2023

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Chemical Dependence Treatment Service

800Service Type:

Program Name:

Certified Capacity:PRU 1188

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10439_Crouse.pdf

January 31, 2022 Page 58 of 227

Certificate Number: 211010567

2nd Floor, 2775 Erie Boulevard East, , Syracuse, New York 13224

Effective: 06/18/2021 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Chemical Dependence Treatment Service

Service Type:

Program Name:

Certified Capacity:PRU 704

with Telepractice Designation

Outpatient Rehabilitation Service (822)

Chemical Dependence Treatment Service

Service Type:

Program Name:

Certified Capacity:PRU 50244

with Telepractice Designation

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

6010 East Molloy Road, Syracuse, New York 13211

Effective: 08/01/2018 7/31/2021

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Commonwealth Place

40Service Type:

Program Name:

Certified Capacity:PRU 52249

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

Paolo Coppola M.D., Executive Director

Suites 1 & 2, 100 Granny Road, Farmingville, NY 11738

Provider Number: 50850

Administrative Office:

Telephone - (631)-696-4357

Certificate Number: 220112176

Suites 1 & 2, 100 Granny Road, , Farmingville, New York 11738

Effective: 08/03/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53315

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12176_CSMedi.pdf

Certificate Number: 210812235

Suites 15 & 16, 1st Floor, 2 Coraci Blvd, , Shirley, New York 11967

Effective: 09/02/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53503

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12235_CSMedi.pdf

Certificate Number: 210912240

2nd Floor, B1, 727 N. Broadway, , Massapequa, New York 11758

Effective: 10/19/2020 9/30/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53505

with Telepractice Designation [with ancillary withdrawal]

January 31, 2022 Page 59 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Delaware County Department of Mental Health

Ms. Cynthia Heaney, Director

243 Delaware Street, Walton, NY 13856

Provider Number: 70050

Administrative Office:

Telephone - (607)-832-5888

Certificate Number: 210510764

243 Delaware Street, , Walton, New York 13856

Effective: 06/05/2020 5/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Delaware County Alcohol and Drug Service

Service Type:

Program Name:

Certified Capacity:PRU 50402

with Telepractice Designation

State University College of Technology at Delhi, 454 Delhi Drive, Delhi, NY 13753

Additional Location(s) At:

2nd Floor, Room 222, 21 Liberty Street, Sidney, NY 13838

Additional Location(s) At:

Margaretville Memorial Hospital, 1st Floor, Conference Room, 42084 State Highway 28, Margaretville, NY 12455

Additional Location(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10764_Delawa.pdf

Delaware Valley Hospital, Inc.

Mr. Rolland Bojo, President/CEO

One Titus Place, Walton, NY 13856

Provider Number: 81740

Administrative Office:

Telephone -

Certificate Number: 240311368

One Titus Place, Walton, New York 13856

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 10Service Type:

Program Name:

Certified Capacity:PRU 51166

with Telepractice Designation

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

Ms. Sue Sullivan, CEO

835 West Main Street, Rochester, NY 14611

Provider Number: 37290

Administrative Office:

Telephone -

Certificate Number: 210811260

835 West Main Street, Rochester, New York 14611

Effective: 01/24/2019 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 6797

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11260_Delphi.pdf

January 31, 2022 Page 60 of 227

Certificate Number: 220512008

Administrative Site Only:, 835 West Main Street, , Rochester, New York 14611

Effective: 09/14/2021 5/31/2022

Program Location:

Amendment Anticipated Recert Review:

Prevention Counseling 0Service Type:

Program Name:

Certified Capacity:PRU 90709

with Telepractice Designation

Newark High School, 1st Floor, Room 210, 625 Peirson Avenue, Newark, NY 14513

Other Service Site(s) At:

Sodus Middle School, 54 Miller Street, Sodus, NY 14551

Other Service Site(s) At:

Clyde-Savannah Elementary School, 215 Glasgow Street, Clyde, NY 14433

Other Service Site(s) At:

Williamson Middle School, 4184 Miller Street, Williamson, NY 14589

Other Service Site(s) At:

Ontario Elementary School, 1st Floor, Room 114, 1784 Ridge Road, Ontario Center, NY 14520

Other Service Site(s) At:

Wayne Technical & Career Center BOCES, 4440 Ridge Road, Williamson, NY 14589

Other Service Site(s) At:

Ontario Primary School, 1st Floor, Room A10, 1730 Ridge Road, Ontario Center, NY 14520

Other Service Site(s) At:

Newark Middle School, 1st Floor, Room 118, 701 Peirson Avenue, Newark, NY 14513

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:

Lyons Middle/High School, 10 Clyde Road, Lyons, NY 14489

Other Service Site(s) At:

Sodus High School, 54 Miller Street, Sodus, NY 14551

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:

North Rose-Wolcott High School, Counselor's Office, 11631 Salter Colvin Road, Wolcott, NY 14590

Other Service Site(s) At:

Perkins Elementary School, 1st Floor, Room 101, 439 West Maple Avenue, Newark, NY 14513

Other Service Site(s) At:

Sodus Elementary School, Route 88, 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:

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:

Williamson Elementary School, 6036 Highland Avenue, Williamson, NY 14589

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:

January 31, 2022 Page 61 of 227

North Rose-Wolcott Leavenworth Middle School, 3rd Floor, Counselor's Office, 5957 Hartford Street, Wolcott, NY 14590

Other Service Site(s) At:

Clyde Savannah Junior/Senior High School, 215 Glasgow Street, Clyde, NY 14433

Other Service Site(s) At:

Freewill Elementary School, 1st Floor, Room 131, 4320 Canandaigua Road, Walworth, NY 14568

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12008_Delphi.pdf

Certificate Number: 220112009

835 West Main Street, Rochester, New York 14611

Effective: 09/14/2021 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90708

with Telepractice Designation

Bay Trail Middle School, 1st Floor, Counseling Office 500L, 1760 Scribner 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:

Paul Road Elementary, 1st Floor, Room 84, 571 Paul Road, Rochester, NY 14624

Other Service Site(s) At:

Gates Chili Middle School, 2 Spartan Way, Rochester, NY 14624

Other Service Site(s) At:

Honeoye Falls Lima Middle School, 619 Quaker Meeting House Road, Honeoye, NY 14472

Other Service Site(s) At:

Florence Brasser Elementary, 1st Floor, Room 122A, 1000 Chili Coldwater Road, Rochester, NY 14606

Other Service Site(s) At:

Gates Chili High School, 1 Spartan Way, Rochester, NY 14624

Other Service Site(s) At:

Cobbles Elementary School, 1st Floor, Conference Room 14J, 140 Gebhardt Road, Penfield, NY 14526

Other Service Site(s) At:

RCSD, Watertower Academy, 5th Floor, Room 516A, 175 Martin Street, Rochester, NY 14605

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:

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:

Brockport Senior High School, 40 Allen Street, Brockport, NY 14622

Other Service Site(s) At:

January 31, 2022 Page 62 of 227

Harris Hill Elementary School, 1st Floor, OT/PT Room 5, 2126 Penfield Road, Penfield, NY 14526

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:

Walt Disney Elementary, 1st Floor, Room 33, 175 Coldwater Road, Rochester, NY 14624

Other Service Site(s) At:

Penfield High School, 1st Floor, 25 High School Drive, Penfield, NY 14526

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

Mr. Norwood Keaton, Executive Director

3rd Floor, 112-06 86th Avenue, Richmond Hill, NY 11418

Provider Number: 11460

Administrative Office:

Telephone - (718)-441-8921

Certificate Number: 241011985

Queens Central Office, 3rd Floor, 112-06 86th Avenue, Richmond Hill, New York 11418

Effective: 11/01/2021 10/31/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90758

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90757

St. Luke School, 16-01 150th Place, Whitestone, NY 11357

Other Service Site(s) At:

St. Mark School, 2602 East 19th Street, Brooklyn, NY 11235

Other Service Site(s) At:

St. Kevin Catholic Academy, 45-5 195th Street, Flushing, NY 11358

Other Service Site(s) At:

St. Sebastian School, 39-76 58th Street, Woodside, NY 11377

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:

Xaverian High School, 7100 Shore Road, Brooklyn, NY 11209

Other Service Site(s) At:

O. L. Guadalupe School, 1518 73rd Street, Brooklyn, NY 11228

Other Service Site(s) At:

Holy Angels Catholic Academy, 347 74th Street, Brooklyn, NY 11209

Other Service Site(s) At:

St. Francis DeSales Catholic Academy, 219 Beach 129th Street, Belle Harbor, NY 11694

Other Service Site(s) At:

Immaculate Conception School, 179-14 Dalny Road, Jamaica, NY 11432

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:

January 31, 2022 Page 63 of 227

Holy Trinity Catholic Academy, 14-45 143rd Street, Whitestone, NY 11357

Other Service Site(s) At:

St. Elizabeth Catholic Academy, 94-01 85th Street, Ozone Park, NY 11416

Other Service Site(s) At:

St. Bernard School, 2030 East 69th Street, Brooklyn, NY 11234

Other Service Site(s) At:

Blessed Sacrament School, 187 Euclid Avenue, Brooklyn, NY 11208

Other Service Site(s) At:

St. Francis Prep High School, 6100 Francis Lewis Boulevard, Fresh Meadows, NY 11365

Other Service Site(s) At:

Immaculate Conception School, 21-63 29th Street, Long Island City, NY 11105

Other Service Site(s) At:

O. L. Grace School, 385 Avenue W, Brooklyn, NY 11223

Other Service Site(s) At:

O. L. Mercy Catholic Academy, 7025 Kessel Street, Forest Hills, NY 11375

Other Service Site(s) At:

Archbishop Molloy High School, 83-53 Manton Street, Jamaica, NY 11435

Other Service Site(s) At:

St. Adalbert, 52-17 83rd Street, Elmhurst, NY 11373

Other Service Site(s) At:

Christo Rey Brooklyn High School, 710 East 37th Street, Brooklyn, NY 11238

Other Service Site(s) At:

Notra Dame Catholic Academy, 61st & Bleecker Streets, Ridgewood, NY 11385

Other Service Site(s) At:

Most Holy Redeemer Catholic Academy, 136-58 41st Avenue, Flushing, NY 11355

Other Service Site(s) At:

Midwood Catholic Academy, 1501 Hendrickson Street, Brooklyn, NY 11204

Other Service Site(s) At:

St. Mel Catholic Academy, 154-24 26th Avenue, Flushing, NY 11354

Other Service Site(s) At:

St. Edmund School, Avenue T/East 19th Street, Brooklyn, NY 11229

Other Service Site(s) At:

St. Francis Assisi Catholic Academy, 400 Lincoln Road, Brooklyn, NY 11225

Other Service Site(s) At:

St. Joseph High School, 80 Willoughby Street, Brooklyn, NY 11201

Other Service Site(s) At:

St. Agnes Academic High School, 13-20 124th Street, College Point, NY 11356

Other Service Site(s) At:

St. Thomas Apostle, 87-49 87th Street, Woodhaven, NY 11421

Other Service Site(s) At:

St. Pancras, 68-20 Myrtle Avenue, Glendale, NY 11385

Other Service Site(s) At:

Bishop Kearney High School, 60th Street/Bay Parkway, Brooklyn, NY 11204

Other Service Site(s) At:

Monsignor McClancy, 71-06 31st Avenue, East Elmhurst, NY 11370

Other Service Site(s) At:

St. Francis Cabrini Catholic Academy, 181 Suydam Street, Brooklyn, NY 11221

Other Service Site(s) At:

January 31, 2022 Page 64 of 227

St. Rose of Lima Catholic Academy, 154 Beach 84th Street, Rockaway Beach, NY 11693

Other Service Site(s) At:

Good Shepherd School, 1943 Brown Street, Brooklyn, NY 11229

Other Service Site(s) At:

St. Leo School, 104-19 49th Avenue, Corona, NY 11368

Other Service Site(s) At:

The Mary Louis Academy, 176-21 Wexford Terrace, Jamaica, NY 11432

Other Service Site(s) At:

St. Saviour High School, 588 6th Street, Brooklyn, NY 11215

Other Service Site(s) At:

Divine Wisdom Catholic Academy, 45-11 245th Street, Douglaston, NY 11363

Other Service Site(s) At:

Holy Cross High School, 26-20 Francis Lewis Boulevard, Flushing, NY 11358

Other Service Site(s) At:

St. Helen Catholic Academy, 82-09 157th Avenue, Howard Beach, NY 11414

Other Service Site(s) At:

Fontbonne Hall Academy, 9901 Shore Road, Brooklyn, NY 11209

Other Service Site(s) At:

St. Francis Xavier Catholic Academy, 763 President Street, Brooklyn, NY 11215

Other Service Site(s) At:

St. Camillus Catholic Academy, 185 Beach 99th Street, Rockaway Beach, NY 11694

Other Service Site(s) At:

Queens Field Office, Holy Child Convent, 112-06 86th Avenue, Richmond Hill, NY 11418

Other Service Site(s) At:

Resurrection Ascension School, 85-25 61st Road, Rego Park, NY 11374

Other Service Site(s) At:

St. Francis Assisi, 21-18 46th Street, Long Island City, NY 11105

Other Service Site(s) At:

St. Nicholas Tolentine School, 80-22 Parsons Boulevard, Jamaica, NY 11432

Other Service Site(s) At:

St. Gregory the Great Catholic Academy, 2520 Church Avenue, Brooklyn, NY 11226

Other Service Site(s) At:

Incarnation School, 89-15 Francis Lewis Boulevard, Queens Village, NY 11427

Other Service Site(s) At:

St. Ephrem School, 741 5 Ft. Hamilton Parkway, Brooklyn, NY 11228

Other Service Site(s) At:

Cathedral Prep School and Seminary, 56-25 92nd Street, Elmhurst, NY 11373

Other Service Site(s) At:

O. L. Trust Catholic Academy, 1696 Canarsie Road, Brooklyn, NY 11236

Other Service Site(s) At:

Sacred Heart Catholic Academy, 115-50 221st Street, Cambria Heights, NY 11411

Other Service Site(s) At:

Queen of the Rosary Catholic Academy, 11 Catherine Street, Brooklyn, NY 11211

Other Service Site(s) At:

St. Savious Catholic Academy, 701 8th Avenue, Brooklyn, NY 11215

Other Service Site(s) At:

Nazareth Regional High School, East 57th/Avenue D, Brooklyn, NY 11203

Other Service Site(s) At:

January 31, 2022 Page 65 of 227

St. Margaret School, 66-10 80th Street, Middle Village, NY 11379

Other Service Site(s) At:

O. L. Lourdes Catholic Academy, 92-80 220th Street, Queens Village, NY 11428

Other Service Site(s) At:

Mary Queens of Heaven, 1326 East 57th Street, Brooklyn, NY 11234

Other Service Site(s) At:

St. Brigid Catholic Academy, 438 Grove Street, Brooklyn, NY 11237

Other Service Site(s) At:

St. Mary Gate of Heaven School, 104-06 101st Avenue, Ozone Park, NY 11416

Other Service Site(s) At:

St. Athanasius School, 6120 Bay Parkway, Brooklyn, NY 11204

Other Service Site(s) At:

St. Bartholomew School, 44-15 Judge Street, Elmhurst, NY 11373

Other Service Site(s) At:

St. Joseph Catholic Academy, 28-46 44th Street, Long Island City, NY 11103

Other Service Site(s) At:

St. Agatha School, 736 48th Street, Brooklyn, NY 11220

Other Service Site(s) At:

Ava Maria Catholic Academy, 158-20 101st Street, 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:

O. L. Perpetual Help Catholic Academy, 111-10 115th Street, South Ozone Park, NY 11420

Other Service Site(s) At:

Devine Wisdom Catholic Academy - Bayside Campus, 56-10 214th Street, Bayside, NY 11364

Other Service Site(s) At:

St. Francis Cabrini, 21 Bay 11th Street, Brooklyn, NY 11208

Other Service Site(s) At:

Holy Family, 74-15 175th Street, Flushing, NY 11366

Other Service Site(s) At:

Sacred Heart School, 84-05 78th Avenue, Glendale, NY 11385

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. Fatima School, 25-38 80th Street, Jackson Heights, NY 11370

Other Service Site(s) At:

St. Stanislaus Kostka Catholic Academy, 10 Newell Street, Brooklyn, NY 11222

Other Service Site(s) At:

Christ the King Regional High School, 68-02 Metropolitan Avenue, Middle Village, NY 11379

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:

St. Joseph the Worker Catholic Academy, 241 Prospect Park West, Brooklyn, NY 11215

Other Service Site(s) At:

St. Patrick Catholic Academy, 420 95th Street, Brooklyn, NY 11209

Other Service Site(s) At:

January 31, 2022 Page 66 of 227

O. L. Queen of Martyrs School, 72-55 Austin Street, Forest Hills, NY 11375

Other Service Site(s) At:

O. L. Hope School, 61-21 71st Street, Middle Village, NY 11379

Other Service Site(s) At:

O. L. Sorrows Catholic Academy, 35-34 105th Street, Corona, NY 11368

Other Service Site(s) At:

O. L. Angelus Catholic Academy, 98-05 63rd Drive, Rego Park, NY 11374

Other Service Site(s) At:

St. Gregory the Great School, 244-44 87th Street, Bellerose, NY 11426

Other Service Site(s) At:

Divine Mercy Catholic Academy, 101-60 90th Street, Ozone Park, NY 11416

Other Service Site(s) At:

St. Stanislaus Kostka School, 61-17 Grand Avenue, Maspeth, NY 11378

Other Service Site(s) At:

Queen of All Saints, 300 Vanderbilt Avenue, Brooklyn, NY 11205

Other Service Site(s) At:

Salve Regina Catholic Academy, 237 Jerome Street, Brooklyn, NY 11207

Other Service Site(s) At:

Catholic Academy of Brooklyn, 5902 6th Avenue, Brooklyn, NY 11220

Other Service Site(s) At:

St. Peter's Catholic Academy, 8401 23rd Avenue, Brooklyn, NY 11214

Other Service Site(s) At:

St. Andrew of Avellino School, 35-50 158th Street, Flushing, NY 11358

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:

Brooklyn Field Office, St. Agatha Convent, 746 48th Street, Brooklyn, NY 11220

Other Service Site(s) At:

St. Edmund Preparatory High School, 2474 Ocean Avenue, Brooklyn, NY 11229

Other Service Site(s) At:

SS Joachim & Anne School, 218-19 105th Avenue, Queens Village, NY 11429

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. John's Preparatory High School, Crescent Street/21st Avenue, Astoria, NY 11105

Other Service Site(s) At:

O. L. Blessed Sacrament School, 34-45 202nd Street, Flushing, NY 11361

Other Service Site(s) At:

St. Anselm Catholic Academy, 83rd Street/4th Avenue, Brooklyn, NY 11209

Other Service Site(s) At:

St. Matthias School, 58-25 Catalpa Avenue, Ridgewood, NY 11385

Other Service Site(s) At:

St. Joan of Arc, 35-27 82nd Street, Jackson Heights, NY 11372

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11985_Depart.pdf

January 31, 2022 Page 67 of 227

Department of Education, Archdiocese of New York

Ms. Christine Cavallucci, Executive Director

2789 Schurz Avenue, Bronx, NY 10465

Provider Number: 27080

Administrative Office:

Telephone - (718)-904-1333 Ext 13

Certificate Number: 230211994

Administrative Office, 2789 Schurz Avenue, Bronx, New York 10465

Effective: 08/20/2021 2/28/2023

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90837

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90833

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90835

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90838

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90839

with Telepractice Designation

Albertus Magnus High School, 1st Floor, ADAPP Office, 798 Route 304, Germonds, Bardonia, NY 10954

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 Mt. Carmel School, 2nd Floor, Library, 59 East Main Street, Elmsford, NY 10523

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:

Immaculate Conception, Winterhill Road, Tuckahoe, 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:

Sacred Heart School, 60 Washington Avenue, Suffern, NY 10901

Other Service Site(s) At:

San Miguel Academy, 241 Liberty Street, Newburgh, NY 12550

Other Service Site(s) At:

John F. Kennedy HS, 54 Route 138, Somers, NY 10589

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:

Sacred Heart High School, Basement, Room B4, 34 Convent Avenue, Yonkers, NY 10703

Other Service Site(s) At:

January 31, 2022 Page 68 of 227

Our Lady of Victory School, 2nd Floor, Art Room, 38 North Fifth Avenue, Mount Vernon, NY 10550

Other Service Site(s) At:

St. John School, 77 Murray Avenue, Goshen, NY 10924

Other Service Site(s) At:

Holy Trinity School, 1st Floor, ADAPP Room, 20 Springside Avenue, Poughkeepsie, NY 12603

Other Service Site(s) At:

John S. Burke Catholic High School, 1st Floor, ADAPP OFFICE, 80 Fletcher Street, Goshen, NY 10924

Other Service Site(s) At:

Our Lady of Lourdes High School, 2nd Floor, Room 201, 131 Boardman Road, Poughkeepsie, NY 12603

Other Service Site(s) At:

Our Lady of Mt. Carmel School, 205 Wawayanda Avenue, Middletown, NY 10940

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:

St. Gregory Barbarigo School, 29 Cinder Road, Garnerville, NY 10932

Other Service Site(s) At:

Salesian High School, 3rd Floor, Room 403, 148 Main Street, New Rochelle, NY 10801

Other Service Site(s) At:

St. Margaret School, 33 North Magnolia Street, Pearl River, NY 10965

Other Service Site(s) At:

St. Augustine School, 1st Floor, ADAPP Office, Route 9, Eagle Park, Ossining, NY 10562

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:

John A. Coleman High School, 430 Hurley Avenue, Hurley, NY 12443

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:

Annunciation School, 1st Floor, Music/Teacher Room, 465 Westchester Avenue, Yonkers, NY 10707

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:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11994_Depart.pdf

January 31, 2022 Page 69 of 227

Certificate Number: 230212006

Administrative Site Only:, 2789 Schurz Avenue, Bronx, New York 10465

Effective: 08/20/2021 2/28/2023

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90771

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90834

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90836

with Telepractice Designation

1st Floor, ADAPP Office, 3893 Dyre Avenue, Bronx, NY 10466

Other Service Site(s) At:

Santa Maria School, 2nd Floor, Adjacent to 4th & 5th Grade Classrooms, 1510 Zerega Avenue, Bronx, NY 10462

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:

St. Jean Baptiste High School, 5th Floor, 173 East 75th Street, New York, NY 10021

Other Service Site(s) At:

St. Frances de Chantal, 4th Floor, Room 406, 2962 Harding Avenue, Bronx, NY 10465

Other Service Site(s) At:

St. Brigid School, 185 East 7th Street, New York, NY 10009

Other Service Site(s) At:

St. Adalbert School, 355 Morningstar Road, Staten Island, NY 10303

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:

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 Peace School, 22 Steele Avenue, Staten Island, NY 10306

Other Service Site(s) At:

St. Angela Merici School, 266 East 163rd Street, Bronx, NY 10451

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:

Our Lady Queen of Angels School, 229 East 112th Street, New York, NY 10029

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:

St. Joseph's Hill Academy, 850 Hylan Boulevard, Staten Island, NY 10305

Other Service Site(s) At:

Cardinal Hayes High School, Mezzanine, ADAPP Office, 650 Grand Concourse, Bronx, NY 10451

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:

January 31, 2022 Page 70 of 227

St. Ann School, 125 Cromwell Avenue, Staten Island, NY 10304

Other Service Site(s) At:

Preston High School, 3rd Floor, Office, 2780 Schurz Avenue, 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:

Immaculate Conception, 1st Floor, Mezzanine, Title I Office, 419 East 13th Street, New York, NY 10009

Other Service Site(s) At:

St. Mark the Evangelist, 55 West 138th Street, New York, NY 10037

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:

St. Joseph School, 2nd Floor, Room 201, 1946 Bathgate Avenue, Bronx, NY 10457

Other Service Site(s) At:

Sacred Heart School, 4th Floor, ADAPP Office, 95 West 168th Street, Bronx, NY 10452

Other Service Site(s) At:

Cathedral High School, 350 East 56th Street, New York, NY 10022

Other Service Site(s) At:

St. Mary School, 3956 Carpenter Avenue, Bronx, NY 10466

Other Service Site(s) At:

St. Athanasius, 3rd Floor, Art Room, 830 Southern Boulevard, Bronx, NY 10459

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:

Holy Rosary School, 1500 Arnow Avenue, Bronx, NY 10469

Other Service Site(s) At:

Holy Rosary Elementary School, Basement, Library, 100 Jerome Avenue, Staten Island, NY 10305

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)

Ms. Jean Marie Niebuhr, Director and Deputy Commissioner of Community Services

230 North Road, Poughkeepsie, NY 12601

Provider Number: 70180

Administrative Office:

Telephone - 845-486-2885

Certificate Number: 210810628

230 North Road, , Poughkeepsie, New York 12601

Effective: 03/15/2021 8/31/2021

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51770

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51924

with Telepractice Designation

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

with Telepractice Designation

January 31, 2022 Page 71 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10628_Dutche.pdf

Dynamic Youth Community, Inc.

Mr. William A. Fusco, Executive Director

1830 Coney Island Avenue, Brooklyn, NY 11230

Provider Number: 105

Administrative Office:

Telephone - (718)-376-7923

Certificate Number: 190210005

Main Building, Women's, Dorm and Men's Dorm, 5803 Route 42, Fallsburg, New York 12733

Effective: 01/01/2018 2/28/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 86Service Type:

Program Name:

Certified Capacity:PRU 813

with Telepractice Designation Main Building - 52 beds for men; Men's Dorm - 10 beds for men; and Women's Dorm - 24 beds for women

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10005_Dynami.pdf

Certificate Number: 210811509

1830 Coney Island Avenue, Brooklyn, New York 11230

Effective: 06/22/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 528

with Telepractice Designation

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

1830 Coney Island Avenue, Brooklyn, New York 11230

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 16Service Type:

Program Name:

Certified Capacity:PRU 52160

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11663_Dynami.pdf

EAC, Inc.

Ms. Tania Peterson Chandler, Interim President & CEO

Suite 107, 50 Clinton Street, Hempstead, NY 11550

Provider Number: 33030

Administrative Office:

Telephone - (516)-539-0150

Certificate Number: 220111510

Suite 403, 4th Floor, 175 Fulton Avenue, , Hempstead, New York 11550

Effective: 09/04/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

EAC Outpatient Clinic

Service Type:

Program Name:

Certified Capacity:PRU 6815

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11510_EACInc.pdf

January 31, 2022 Page 72 of 227

Eastern Niagara Hospital, Inc.

Ms. Anne McCaffrey, Chief Executive Officer

521 East Avenue, Lockport, NY 14094

Provider Number: 81760

Administrative Office:

Telephone - (716)-514-5502

Certificate Number: 220311372

North Building, 3rd Floor, 521 East Avenue, , Lockport, New York 14094

Effective: 04/04/2020 3/31/2022

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Reflections Recovery Centre

30Service Type:

Program Name:

Certified Capacity:PRU 51208

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11372_Easter.pdf

EBDK at Calverton, LLC d/b/a Wellbridge

Mr. Christopher Yadron, Chief Executive Officer

525 Jan Way, Calverton, NY 11933

Provider Number: 51130

Administrative Office:

Telephone - (516)-841-6363

Certificate Number: 220312209

, New York

Effective: 10/01/2021 3/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Wellbridge Rehabilitation Program

50Service Type:

Program Name:

Certified Capacity:PRU 53478

with up to 8 beds for the provision of Part 816.7 medically supervised withdrawal and stabilization services with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12209_EBDKat.pdf

Certificate Number: 220312216

525 Jan Way, , Calverton, New York 11933

Effective: 10/01/2021 3/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

Wellbridge Stabilization Program

10Service Type:

Program Name:

Certified Capacity:PRU 53476

with up to 8 beds for the provision of Part 818 inpatient rehabilitation services with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12216_EBDKat.pdf

Certificate Number: 210412217

525 Jan Way, , Calverton, New York 11933

Effective: 03/15/2021 4/30/2021

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Wellbridge Residential Program

8Service Type:

Program Name:

Certified Capacity:PRU 53477

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12217_EBDKat.pdf

The Educational Alliance, Inc.

Mr. Alan vanCapelle, President and CEO

197 East Broadway, New York, NY 10002

Provider Number: 70590

Administrative Office:

Telephone - (646)-395-4060

January 31, 2022 Page 73 of 227

Certificate Number: 230611537

New Side, 1st, 2nd and 3rd Floors, 25-29 Avenue D, New York, New York 10009

Effective: 07/01/2021 6/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Project Contact

Service Type:

Program Name:

Certified Capacity:PRU 55

with Telepractice Designation

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

Original Side, New Side - 4th - 6th Floor, Basement - 6th Floor, 25-29 Avenue D, New York, New York 10009

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Pride Site

100Service Type:

Program Name:

Certified Capacity:PRU 53069

with Telepractice Designation [16 beds for women only - 4th Floor]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12073_TheEdu.pdf

EHS, Inc.

Mr. Raymond Ganoe, President/CEO

206 South Elmwood Avenue, Buffalo, NY 14201

Provider Number: 38260

Administrative Office:

Telephone - (716)-847-2441

Certificate Number: 220911877

4th Floor, 206 South Elmwood Avenue, Buffalo, New York 14201

Effective: 05/04/2020 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52843

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11877_EHSInc.pdf

Elev8 Center New York, LLC

Ms. Donna Mae DePola, Executive Director

151 West 136th Street, New York, NY 10030

Provider Number: 50200

Administrative Office:

Telephone - (646)-819-0827

Certificate Number: 220812151

3rd Floor, 151 West 136th Street, New York, New York 10030

Effective: 08/21/2020 8/31/2022

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 37Service Type:

Program Name:

Certified Capacity:PRU 53268

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]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12151_Elev8C.pdf

January 31, 2022 Page 74 of 227

Certificate Number: 221212153

2nd Floor, 151 West 136th Street, New York, New York 10030

Effective: 01/01/2020 12/31/2022

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 38Service Type:

Program Name:

Certified Capacity:PRU 53270

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]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12153_Elev8C.pdf

Elmcor Youth & Adult Activities, Inc.

Ms. Saeeda Dunston, Executive Director

2nd Floor, 107-20 Northern Boulevard, Corona, NY 11368

Provider Number: 114

Administrative Office:

Telephone - (718)-651-0096 Ext 237

Certificate Number: 181211300

(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

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 51Service Type:

Program Name:

Certified Capacity:PRU 1283

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11300_Elmcor.pdf

Certificate Number: 210611512

1st Floor, 107-20 Northern Boulevard, , Corona, New York 11368

Effective: 03/05/2019 6/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 458

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11512_Elmcor.pdf

Certificate Number: 231011969

2nd Floor, 33-16 108th Street, , Corona, New York 11368

Effective: 11/01/2021 10/31/2023

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90736

with Telepractice Designation

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.

Dr Simon D. Zysman Ph.D., Founder and President

Suite B, 278 East Main Street, Smithtown, NY 11787

Provider Number: 1413

Administrative Office:

Telephone - (516)-361-6960

January 31, 2022 Page 75 of 227

Certificate Number: 240510768

278 East Main Street, Smithtown, New York 11787

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 4164

[with ancillary withdrawal services]

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 Inc, dba So

Mr Thomas Hopkins, CEO

91 Guy Lombardo Avenue, Freeport, NY 11520

Provider Number: 50580

Administrative Office:

Telephone - (516)-739-7733 Ext 100

Certificate Number: 230611999

91 Guy Lombardo Avenue, Freeport, New York 11520

Effective: 11/23/2021 6/30/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Children's Addiction Resources and Education Center (C.A.R.E.)

Service Type:

Program Name:

Certified Capacity:PRU 52960

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11999_EPICFa.pdf

Equinox, Inc.

Ms. Virginia Golden, Chief Executive Officer

500 Central Avenue, Albany, NY 12206

Provider Number: 14510

Administrative Office:

Telephone - (518)-435-9931 Ext 5240

Certificate Number: 220511801

1st Floor, 500 Central Avenue, , Albany, New York 12206

Effective: 06/01/2021 5/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)

Counseling Center

Service Type:

Program Name:

Certified Capacity:PRU 52689

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11801_Equino.pdf

Erie County Medical Center Corporation

Thomas J. Quatroche Jr, Ph.D., President and CEO

462 Grider Street, Buffalo, NY 14215

Provider Number: 85150

Administrative Office:

Telephone - (716)-898-3000

Certificate Number: 240810282

Zone 3 (18 beds), 9th Floor, 462 Grider Street, Zone 4 (14 beds), Buffalo, New York 14215

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Medically Managed Withdrawal & Stabilization Services (816.6) 32Service Type:

Program Name:

Certified Capacity:PRU 50276

[with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10282_ErieCo.pdf

January 31, 2022 Page 76 of 227

Certificate Number: 240610770

1st Floor, 2005 Sheridan Drive, , Tonawanda, New York 14223

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Northern Erie Clinical Services

Service Type:

Program Name:

Certified Capacity:PRU 50282

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10770_ErieCo.pdf

Certificate Number: 240610771

2nd Floor, 1285 Main Street, Buffalo, New York 14209

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50278

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10771_ErieCo.pdf

Certificate Number: 210311369

9th Floor, Zone 1, 462 Grider Street, Buffalo, New York 14215

Effective: 04/01/2018 3/31/2021

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 20Service Type:

Program Name:

Certified Capacity:PRU 50277

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11369_ErieCo.pdf

Certificate Number: 240611811

5087 Broadway, Depew, New York 14043

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52700

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11811_ErieCo.pdf

Exodus Transitional Community, Inc.

Mr. Julio Medina, Executive Director

2271 3rd Avenue, New York, NY 10035

Provider Number: 49050

Administrative Office:

Telephone - (917)-492-0990 Ext 175

Certificate Number: 210211947

2nd & 3rd Floors, 2271 3rd Avenue, New York, New York 10035

Effective: 03/01/2019 2/28/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52922

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11947_Exodus.pdf

Exponents, Inc.

Mr. Joseph Turner J.D., President and Chief Executive Officer

8th Floor, 17 Battery Place, New York, NY 10004

Provider Number: 2015

Administrative Office:

Telephone - (212)-243-3434 Ext 339

January 31, 2022 Page 77 of 227

Certificate Number: 221010773

8th Floor, 17 Battery Place, New York, New York 10004

Effective: 06/02/2020 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7128

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10773_Expone.pdf

Fairview Recovery Services, Inc.

Mr. Patrick Haley LMSW, Executive Director

5 Merrick Street, Binghamton, NY 13904

Provider Number: 36020

Administrative Office:

Telephone - (607)-722-8987 Ext 224

Certificate Number: 190610143

5 Merrick Street, , Binghamton, New York 13904

Effective: 01/01/2018 6/30/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819)

Fairview Supportive Living Program

45Service Type:

Program Name:

Certified Capacity:PRU 50092

with Telepractice Designation for adults and their children {case records and administrative offices are located at 116 Fairview Avenue, Binghamton}

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10143_Fairvi.pdf

Certificate Number: 200312085

Basement & 1st Floor, 247 Court Street, Binghamton, New York 13901

Effective: 04/01/2019 3/31/2020

Program Location:

Extended Establishmen Anticipated Recert Review:

Residential Services (820) 20Service Type:

Program Name:

Certified Capacity:PRU 53123

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12085_Fairvi.pdf

Certificate Number: 200212166

8 Clapham Street, , Binghamton, New York 13904

Effective: 04/10/2019 2/29/2020

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

New Outlook

18Service Type:

Program Name:

Certified Capacity:PRU 53301

with Telepractice Designation [adult beds are for women]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12166_Fairvi.pdf

Certificate Number: 200212167

5 Merrick Street, , Binghamton, New York 13904

Effective: 04/10/2019 2/29/2020

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Fairview Recovery Services

24Service Type:

Program Name:

Certified Capacity:PRU 53302

with Telepractice Designation [for men]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12167_Fairvi.pdf

January 31, 2022 Page 78 of 227

Family & Children's Service of the Capital Region, Inc. d/b/a Capital Counseling

Ms. Kandie Sawyer, Chief Executive Office

650 Warren Street, Albany, NY 12208

Provider Number: 26330

Administrative Office:

Telephone - (518)-462-6531 Ext 114

Certificate Number: 211012242

1st Floor, 650 Warren Street, , Albany, New York 12208

Effective: 11/18/2020 10/31/2021

Program Location:

Establishment Anticipated Recert Review:

Chemical Dependency Specialized Services (824)

Center for Problem Gambling

0Service Type:

Program Name:

Certified Capacity:PRU 53502

with Problem Gambling designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Family and Children's Association

Mr. Jeffrey L. Reynolds, President/CEO

Suite 24, 100 East Old Country Road, Mineola, NY 11501

Provider Number: 30120

Administrative Office:

Telephone - (516)-746-0350

Certificate Number: 221210774

180 Broadway, Hicksville, New York 11801

Effective: 01/01/2021 12/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Hicksville Drug Counseling Center

Service Type:

Program Name:

Certified Capacity:PRU 50923

[with ancillary withdrawal services] with Telepractice Designation

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

126 North Franklin Street, Hempstead, New York 11550

Effective: 12/01/2019 11/30/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90665

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11966_Family.pdf

Family Counseling Services of Cortland County, Inc.

Ms. Lisa W. Hoeschele, CEO & Executive Director

Suite B, 1st Floor, 165-177 Main Street, Cortland, NY 13045

Provider Number: 36350

Administrative Office:

Telephone - (607)-753-0234

Certificate Number: 211110777

1st Floor, 165-177 Main Street, Cortland, New York 13045

Effective: 04/15/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50991

with Telepractice Designation

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

January 31, 2022 Page 79 of 227

Family Service League, Inc.

Ms. Karen Boorshtein, President and Chief Executive Officer

790 Park Avenue, Huntington, NY 11743

Provider Number: 50440

Administrative Office:

Telephone - (631)-470-6780

Certificate Number: 220510635

1448 Fifth Avenue, , Bayshore, New York 11706

Effective: 04/05/2021 5/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Family Recovery Center

Service Type:

Program Name:

Certified Capacity:PRU 51813

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10635_Family.pdf

Certificate Number: 220710779

1235 Montauk Highway , , Mastic, New York 11950

Effective: 08/01/2019 7/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Family Recovery Center

Service Type:

Program Name:

Certified Capacity:PRU 50994

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10779_Family.pdf

Certificate Number: 220711602

Suite 300, 3rd Floor, 400 West Main Street, , Riverhead, New York 11901

Effective: 08/01/2019 7/31/2022

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)

Family Recovery Center

Service Type:

Program Name:

Certified Capacity:PRU 52084

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11602_Family.pdf

Certificate Number: 210312229

Suite C, 90 Adams Avenue, , Hauppauge, New York 11788

Effective: 04/13/2020 3/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53494

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12229_Family.pdf

Family Service Society, Inc.

Ms. Harmony Ayers-Friedlander, Executive Director

280 Princeton Avenue Ext., Corning, NY 14830

Provider Number: 396

Administrative Office:

Telephone - (607)-962-3148 Ext 216

Certificate Number: 220111993

Administrative Site at: Corning Area Youth Center, Office #9, 2nd Floor, 79 Flint Avenue, Corning, New York 14830

Effective: 02/01/2020 1/31/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90585

January 31, 2022 Page 80 of 227

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

Mr. Eric A. Bresee MS, LMHC, Executive Director

283 West 2nd Street, Oswego, NY 13126

Provider Number: 15660

Administrative Office:

Telephone - (315)-342-4489 Ext 2260

Certificate Number: 220610782

1st Floor, 283 West 2nd Street, , Oswego, New York 13126

Effective: 07/01/2021 6/30/2022

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 687

with Telepractice Designation [with ancillary withdrawal services]

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

1st Floor, 283 West 2nd Street, , Oswego, New York 13126

Effective: 05/29/2020 4/30/2022

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90648

with Telepractice Designation

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:

Fulton Community School, 129 Curtis Street, Fulton, NY 13069

Other Service Site(s) At:

Frederick Leighton Elementary School, 1 Buccaneer Boulevard, Oswego, NY 13126

Other Service Site(s) At:

Oswego Middle School, 10 Mark Fitzgibbons Drive, Oswego, NY 13126

Other Service Site(s) At:

Kingsford Park School, Data Room, 275 West 5th Street, Oswego, NY 13126

Other Service Site(s) At:

John C. Birdlebough High School, 552 Main Street, Phoenix, NY 13135

Other Service Site(s) At:

Volney Elementary School, 1st Floor, Counseling, 2592 State Route 3, Fulton, NY 13069

Other Service Site(s) At:

Emerson J. Dillon Middle School (Phoenix), 116 Volney Street, Phoenix, NY 13135

Other Service Site(s) At:

Hannibal High School, 928 Cayuga Street, Hannibal, NY 13074

Other Service Site(s) At:

Altmar-Parish-Williamstown High School, 639 County Route 22, Parish, NY 13131

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:

January 31, 2022 Page 81 of 227

Pulaksi Elementary School, 1st Floor, Counseling, 2 Hinman Road, Pulaski, NY 13142

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:

Minetto Elementary School, All Purpose Room, 2411 County Route 8, Oswego, NY 13126

Other Service Site(s) At:

Sandy Creek High School, PO Box 248, Sandy Creek, NY 13145

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 Middle School, 16 Fravor Road, Mexico, NY 13114

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:

G. Ray Bodley High School (Fulton), 6 William Gillard Drive, Fulton, NY 13069

Other Service Site(s) At:

Mexico High School, 3338 Main Street, Mexico, NY 13114

Other Service Site(s) At:

Pulaski Middle School, 4624 Salina Street, Pulaski, NY 13142

Other Service Site(s) At:

Pulaski High School, 4624 Salina Street, Pulaski, NY 13142

Other Service Site(s) At:

Fitzhugh Park Elementary School, 195 E. Bridge Street, Oswego, NY 13126

Other Service Site(s) At:

Charles E. Riley Elementary School, 269 East 8th Street, Oswego, NY 13126

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:

Oswego High School, 2 Buccaneer Boulevard, Oswego, NY 13126

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11988_Farnha.pdf

Certificate Number: 210812115

1st Floor, 283 West Second Street, , Oswego, New York 13126

Effective: 01/24/2019 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Farnham Family Services OTP

100Service Type:

Program Name:

Certified Capacity:PRU 53016

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12115_Farnha.pdf

Certificate Number: 220612269

1st Floor, 111 Hamilton Street, , Mexico, New York 13114

Effective: 06/23/2021 6/30/2022

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53560

with Telepractice Designation

January 31, 2022 Page 82 of 227

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.

Ms. Barbara Faron, CEO

1 Farmingdale Avenue, West Babylon, NY 11704

Provider Number: 16290

Administrative Office:

Telephone - (631)-559-5355

Certificate Number: 211212230

1375 Akron Street, , Copiague, New York 11726

Effective: 01/04/2021 12/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53500

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12230_Federa.pdf

Finger Lakes Area Counseling and Recovery Agency, Inc.

Ms. Jennifer Carlson, CEO

5th Floor, 28 East Main Street, Clifton Springs, NY 14432

Provider Number: 39040

Administrative Office:

Telephone - (315)-462-9148

Certificate Number: 181210179

5th Floor, 28 East Main Street, Clifton Springs, New York 14432

Effective: 12/03/2018 12/31/2018

Program Location:

Amendment Anticipated Recert Review:

Supportive Living (819) 54Service Type:

Program Name:

Certified Capacity:PRU 51066

with Telepractice Designation

Supportive Living (819) 8Service Type:

Program Name:

Certified Capacity:PRU 51794

with Telepractice Designation

Supportive Living (819) 11Service Type:

Program Name:

Certified Capacity:PRU 52699

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10179_Finger.pdf

Certificate Number: 210910784

1st and 2nd Floors, 246 Castle Street, , Geneva, New York 14456

Effective: 10/06/2020 9/30/2021

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 51067

[with ancillary withdrawal services] with Telepractice Designation

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10784_Finger.pdf

January 31, 2022 Page 83 of 227

Certificate Number: 210710785

3rd Floor, 28 East Main Street, Clifton Springs, New York 14432

Effective: 05/06/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50072

[with ancillary withdrawal services] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10785_Finger.pdf

Certificate Number: 211010786

310 West Union Street, Newark, New York 14513

Effective: 11/01/2019 10/31/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

FLACRA Addictions Clinic

0Service Type:

Program Name:

Certified Capacity:PRU 50074

[with ancillary withdrawal services] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10786_Finger.pdf

Certificate Number: 200911569

1 Keuka Business Park, 3rd Floor, 2466 Route 54A, , Penn Yan, New York 14527

Effective: 05/06/2020 9/30/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Penn Yan Outpatient Clinic

Service Type:

Program Name:

Certified Capacity:PRU 51986

[with ancillary withdrawal services] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11569_Finger.pdf

Certificate Number: 221211570

Suite 3, 1st Floor, 106 South Perry Street, Watkins Glen, New York 14891

Effective: 05/06/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

FLACRA Addictions Clinic

0Service Type:

Program Name:

Certified Capacity:PRU 51717

[with ancillary withdrawal services] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11570_Finger.pdf

Certificate Number: 220411816

1386 Hathaway Drive, , Farmington, New York 14425

Effective: 05/06/2020 4/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52776

[with ancillary withdrawal services] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11816_Finger.pdf

Certificate Number: 201111824

Building 14, 2650 East Street, , Canandaigua, New York 14424

Effective: 10/28/2019 11/30/2020

Program Location:

Amendment Anticipated Recert Review:

Community Residential (819) 15Service Type:

Program Name:

Certified Capacity:PRU 52685

with Telepractice Designation

January 31, 2022 Page 84 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11824_Finger.pdf

Certificate Number: 221111948

4th Floor, 28 East Main Street, , Clifton Springs, New York 14432

Effective: 12/01/2019 11/30/2022

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 11Service Type:

Program Name:

Certified Capacity:PRU 52926

with Telepractice Designation - [up to 11 beds may be used for the provision of residential services (stabilization)]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11948_Finger.pdf

Certificate Number: 210112132

Otte Hall, 621 Church Street, Newark, New York 14513

Effective: 02/01/2020 1/31/2021

Program Location:

Conditional Certificate Anticipated Recert Review:

Residential Services (820) 23Service Type:

Program Name:

Certified Capacity:PRU 53226

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12132_Finger.pdf

Certificate Number: 190312133

2nd Floor, 28 East Main Street, Clifton Springs, New York 14432

Effective: 12/03/2018 3/31/2019

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820) 19Service Type:

Program Name:

Certified Capacity:PRU 53227

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12133_Finger.pdf

Certificate Number: 200512173

4th Floor, 28 East Main Street, , Clifton Springs, New York 14432

Effective: 06/10/2019 5/31/2020

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Addictions Crisis Center

12Service Type:

Program Name:

Certified Capacity:PRU 53308

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

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12173_Finger.pdf

First Steps to Recovery, Inc.

Ms. Allyne Spinner LCSW, Executive Director

Ground Floor, 312 West 47th Street, New York, NY 10036

Provider Number: 2090

Administrative Office:

Telephone - (212)-307-5280

Certificate Number: 200510787

Ground Floor, 310-312 West 47th Street, New York, New York 10036

Effective: 11/01/2019 5/31/2020

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6272

with Telepractice Designation

January 31, 2022 Page 85 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10787_FirstS.pdf

Certificate Number: 200411261

1st Floor, 2990 Brighton 12th Street, Brooklyn, New York 11235

Effective: 11/01/2019 4/30/2020

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7334

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11261_FirstS.pdf

Five Towns Community Center, Inc.

Mr. K. Brent Hill, Executive Director

270 Lawrence Avenue, Lawrence, NY 11559

Provider Number: 33240

Administrative Office:

Telephone - (516)-239-6244 Ext 234

Certificate Number: 220811513

Rooms S4, S10-S17, S19, S25, and S31, 2nd Floor, 270 Lawrence Avenue, , Lawrence, New York 11559

Effective: 09/22/2020 8/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 765

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11513_FiveTo.pdf

Flushing Hospital and Medical Center

Mr. Bruce J. Flanz, President & CEO

4500 Parsons Boulevard, Flushing, NY 11355

Provider Number: 82070

Administrative Office:

Telephone - (718)-670-5918

Certificate Number: 221110246

4500 Parsons Boulevard, , Flushing, New York 11355

Effective: 02/08/2021 11/30/2022

Program Location:

Amendment Anticipated Recert Review:

Medically Managed Withdrawal & Stabilization Services (816.6) 30Service Type:

Program Name:

Certified Capacity:PRU 51644

[with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10246_Flushi.pdf

Certificate Number: 221010788

4500 Parsons Boulevard, , Flushing, New York 11355

Effective: 01/13/2021 10/31/2022

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51827

with Telepractice Designation

Integrated Outpatient Services - PCService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10788_Flushi.pdf

January 31, 2022 Page 86 of 227

Forensic Consultants, Ltd.

Mr. Michael Montgomery, Executive Director

2112 Erie Boulevard E, Syracuse, NY 13224

Provider Number: 16530

Administrative Office:

Telephone - (315)-472-1212

Certificate Number: 210410789

Suite 200, 2112 Erie Boulevard East, Syracuse, New York 13224

Effective: 05/01/2019 4/30/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51472

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10789_Forens.pdf

The Fortune Society, Inc.

Ms. JoAnne Page Esq., CEO & President

29-76 Northern Boulevard, Long Island City, NY 11101

Provider Number: 1523

Administrative Office:

Telephone - (347)-510-3408

Certificate Number: 240611539

29-76 Northern Boulevard, Long Island City, New York 11101

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6287

with Telepractice Designation

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.

Ms. Rachel Russell, Chief Clinical Officer

13th Floor, 515 Madison Avenue, New York, NY 10022

Provider Number: 32106

Administrative Office:

Telephone - (212)-838-0044 Ext 0016

Certificate Number: 231110791

Suite 13B, 13th Floor, 515 Madison Avenue, , New York, New York 10022

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51015

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10791_Freedo.pdf

Friends of Bridge, Inc.

Mr. James Wyler, Executive Director

5-11 Pflug Place, Valley Stream, NY 11580

Provider Number: 139

Administrative Office:

Telephone - (516)-825-4242

Certificate Number: 220111515

5-11 Pflug Place, Valley Stream, New York 11580

Effective: 06/10/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 239

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11515_Friend.pdf

January 31, 2022 Page 87 of 227

From the Ashes, Inc. d/b/a The Kenneth Peters Center for Recovery

Mr. Eric Frieman, Aministrative Director

Suite 122 W, 1st Floor, 6800 Jericho Turnpike, Syosset, NY 11788

Provider Number: 17580

Administrative Office:

Telephone - (914)-907-4753

Certificate Number: 210410793

Suite 122W, 1st Floor, 6800 Jericho Turnpike, Syosset, New York 11791

Effective: 05/28/2020 4/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

The Kenneth Peters Center for Recovery

Service Type:

Program Name:

Certified Capacity:PRU 51619

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10793_Fromth.pdf

Certificate Number: 210411637

1st Floor, 300 Motor Parkway, Hauppauge, New York 11788

Effective: 05/28/2020 4/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

The Kenneth Peters Center for Recovery

Service Type:

Program Name:

Certified Capacity:PRU 52130

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11637_Fromth.pdf

Fulton Friendship House, Inc.

Mr. Thomas Ryan, Executive Director

18 Cayadutta Street, P.O. Box 292, Gloversville, NY 12078

Provider Number: 12190

Administrative Office:

Telephone - (518)-725-1512

Certificate Number: 211210015

Victorian Manor, 1st-3rd Floors, Basement, 8-10 First Avenue, Gloversville, New York 12078

Effective: 01/01/2019 12/31/2021

Program Location:

Renewal Anticipated Recert Review:

Community Residential (819) 20Service Type:

Program Name:

Certified Capacity:PRU 51297

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10015_Fulton.pdf

Garnet Health Medical Center

Mr. Jonathan Schiller, CEO

707 East Main Street, Middletown, NY 10940

Provider Number: 81420

Administrative Office:

Telephone - 845-794-3300 Ext 2100

Certificate Number: 240511335

Suite 135, 75 Crystal Run Road, Middletown, New York 10941

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Horton Family Program for Alcoholism and Chemical Dependency

Service Type:

Program Name:

Certified Capacity:PRU 50932

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11335_Garnet.pdf

Genesee Council on Alcoholism and Substance Abuse, Inc.

Mr. John P. Bennett, Executive Director

430 East Main Street, Batavia, NY 14020

Provider Number: 38100

Administrative Office:

Telephone - (585)-815-1850

January 31, 2022 Page 88 of 227

Certificate Number: 191110168

2nd Floor, 430 East Main Street, Batavia, New York 14020

Effective: 01/01/2018 11/30/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819) 24Service Type:

Program Name:

Certified Capacity:PRU 51739

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10168_Genese.pdf

Certificate Number: 181210169

424 East Main Street, Batavia, New York 14020

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 17Service Type:

Program Name:

Certified Capacity:PRU 51203

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10169_Genese.pdf

Certificate Number: 221010795

430 East Main Street, , Batavia, New York 14020

Effective: 01/03/2022 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Genesee Council Clinic

Service Type:

Program Name:

Certified Capacity:PRU 50546

with Problem Gambling and Telepractice Designations

Opioid Treatment Program (822)

Genesee Council Clinic

150Service Type:

Program Name:

Certified Capacity:PRU 53610

with Problem Gambling and Telepractice Designations

Capacity Lifted

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

1st Floor & Basement, 249 East Avenue & 166 McKinstry Street, Albion, New York 14411

Effective: 05/28/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Genesee Council Clinic

Service Type:

Program Name:

Certified Capacity:PRU 51798

with Problem Gambling and Telepractice Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10797_Genese.pdf

Certificate Number: 230112295

424 E. Main St. , , Batavia, New York 14020

Effective: 01/25/2022 1/31/2023

Program Location:

Establishment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 16Service Type:

Program Name:

Certified Capacity:PRU 53600

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12295_Genese.pdf

Genesis Detox of Brooklyn, LLC

Mr. Samuel Benitez, Chief Executive Officer

449 39th Street, Brooklyn, NY 11232

Provider Number: 49600

Administrative Office:

Telephone - (718)-633-4673 Ext 115

January 31, 2022 Page 89 of 227

Certificate Number: 240912064

449 39th Street, Brooklyn, New York 11232

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 35Service Type:

Program Name:

Certified Capacity:PRU 53059

- with the use of methadone

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12064_Genesi.pdf

Good Samaritan Hospital of Suffern, N.Y.

Mary Leahy M.D., CEO

2nd Floor, 255 Lafayette Avenue, Suffern, NY 10901

Provider Number: 85370

Administrative Office:

Telephone - (845)-368-5303

Certificate Number: 211110297

3rd Floor, 255 Lafayette Avenue, Suffern, New York 10901

Effective: 01/31/2019 11/10/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6) 6Service Type:

Program Name:

Certified Capacity:PRU 4494

- with the use of methadone

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10297_GoodSa.pdf

Certificate Number: 211111370

3rd Floor, 255 Lafayette Avenue, Suffern, New York 10901

Effective: 01/31/2019 11/10/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818) 11Service Type:

Program Name:

Certified Capacity:PRU 6972

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11370_GoodSa.pdf

Greenwich House, Inc.

Mr. Darren Bloch, Chief Executive Officer

6th Floor, 122 West 27th Street, New York, NY 10001

Provider Number: 50730

Administrative Office:

Telephone - (212)-991-0003 Ext 201

Certificate Number: 211110382

190 Mercer Street, New York, New York 10012

Effective: 10/02/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Greenwich House East

800Service Type:

Program Name:

Certified Capacity:PRU 18

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10382_Greenw.pdf

Certificate Number: 240610801

6th Floor, 122 West 27th Street, New York, New York 10001

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Greenwich House Counseling Center

Service Type:

Program Name:

Certified Capacity:PRU 586

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10801_Greenw.pdf

January 31, 2022 Page 90 of 227

The Guidance Center of Westchester, Inc.

Ms. Amy Gelles, Executive Director

256 Washington Street, Mount Vernon, NY 10553

Provider Number: 23500

Administrative Office:

Telephone - (914)-613-0700 Ext 7074

Certificate Number: 221110359

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

Effective: 12/01/2020 11/30/2022

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Opioid Treatment Program (822) 250Service Type:

Program Name:

Certified Capacity:PRU 397

with Telepractice Designation

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10359_Guidan.pdf

Certificate Number: 211111787

3rd and 4th Floors, 256 Washington Street, Mount Vernon, New York 10553

Effective: 12/01/2020 11/30/2021

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)

Mount Vernon Sunrise

Service Type:

Program Name:

Certified Capacity:PRU 52641

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11787_Guidan.pdf

Halfway Houses of Westchester, Inc.

Mr. Aflred Pride, Executive Director

1st Floor, 14 Longview Avenue, White Plains, NY 10605

Provider Number: 34020

Administrative Office:

Telephone - (914)-946-0949

Certificate Number: 181210115

1st & 2nd Floors, Basement,, 14 Longview Avenue, White Plains, New York 10605

Effective: 01/01/2018 12/31/2018

Program Location:

Conditional Certificate Anticipated Recert Review:

Community Residential (819)

Hawthorne House

10Service Type:

Program Name:

Certified Capacity:PRU 50061

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10115_Halfwa.pdf

Hamilton-Madison House, Inc.

Ms. Isabel Ching, Executive Director

2nd Floor, 253 South Street, New York, NY 10002

Provider Number: 50370

Administrative Office:

Telephone - (212)-349-3724 Ext 9321

Certificate Number: 211010804

2nd Floor, 253 South Street, New York, New York 10002

Effective: 10/02/2020 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Asian American Recovery Services

Service Type:

Program Name:

Certified Capacity:PRU 50049

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10804_Hamilt.pdf

January 31, 2022 Page 91 of 227

HANAC, Inc.

Mr. John P. Kaiteris, Chief Operating Officer

27-40 Hoyt Avenue South, Astoria, NY 11102

Provider Number: 16670

Administrative Office:

Telephone - (212)-204-1200 Ext 105

Certificate Number: 210611516

2nd Floor, 31-14 30th Avenue, Astoria, New York 11102

Effective: 08/25/2020 6/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6118

with Telepractice Designation

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

Ms. Marcia Allen-Booker, CEO

249 Pennsylvania Avenue, Brooklyn, NY 11207

Provider Number: 48040

Administrative Office:

Telephone - (347)-547-3626

Certificate Number: 221012036

2nd and 3rd Floors, 249 Pennsylvania Avenue, Brooklyn, New York 11207

Effective: 07/03/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52619

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12036_Handso.pdf

Harrison Youth Council, Inc.

Ms. Amanda Ammirati, Executive Director

1st Floor, 84 Calvert Street, Harrison, NY 10528

Provider Number: 27910

Administrative Office:

Telephone - (914)-835-7500

Certificate Number: 211211971

1st Floor, 84 Calvert Street, Harrison, New York 10528

Effective: 07/02/2021 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90663

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11971_Harris.pdf

Hazelden/New York

Ms. Eliana Leve, Director NY Services

12th Floor, 322 8th Avenue, New York, NY 10001

Provider Number: 2141

Administrative Office:

Telephone - (646)-601-7028

Certificate Number: 210811517

12th Floor, 322 8th Avenue, , New York, New York 10001

Effective: 07/03/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6978

with Telepractice Designation

January 31, 2022 Page 92 of 227

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.

Ms. Maria Siebel, CEO

6209 16th Avenue, Brooklyn, NY 11204

Provider Number: 49950

Administrative Office:

Telephone - (718)-234-0073

Certificate Number: 230912161

6209 16th Avenue, , Brooklyn, New York 11204

Effective: 06/16/2021 9/30/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53210

with Telepractice Designation

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

Ms Dawn V. Saffayeh, Executive Director

St. Vincent's Services, Inc. as Operator, 5th Floor, 66 Boerum Place, Brooklyn, NY 11201

Provider Number: 22300

Administrative Office:

Telephone - (718)-422-2302

Certificate Number: 200911020

Basement & 1st Floor, 66 Boerum Place, Brooklyn, New York 11201

Effective: 10/01/2018 9/30/2020

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 7310

with Telepractive Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11020_Hearts.pdf

Helio Health, Inc.

Mr. Jeremy Klemanski, Chief Executive Officer

555 E. Genesee Street, Syracuse, NY 13202

Provider Number: 36090

Administrative Office:

Telephone - (315)-474-5506

Certificate Number: 200811038

1st, 2nd & 3rd Floors, 329 North Salina Street, , Syracuse, New York 13203

Effective: 04/15/2020 8/31/2020

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Outpatient Service (822)

Meadows Outpatient Services

0Service Type:

Program Name:

Certified Capacity:PRU 50041

with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

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

January 31, 2022 Page 93 of 227

Certificate Number: 210911408

1st & 2nd Floors, Basement,, 847 James Street, , Syracuse, New York 13203

Effective: 01/01/2021 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Helio Health Inpatient Facility

40Service Type:

Program Name:

Certified Capacity:PRU 50040

- [up to 40 beds may be used for the provision of medically supervised inpatient withdrawal & stabilization services, as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11408_HelioH.pdf

Certificate Number: 211111455

1st Floor & Lower Level, 847 James Street, , Syracuse, New York 13203

Effective: 01/01/2021 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

Evaluation Center

25Service Type:

Program Name:

Certified Capacity:PRU 51962

- [up to 25 beds may be used for the provision of inpatient rehabilitation services, as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11455_HelioH.pdf

Certificate Number: 220811707

1st Floor & Annex B, 1350 University Avenue, , Rochester, New York 14607

Effective: 04/30/2021 8/31/2022

Program Location:

Amendment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 30Service Type:

Program Name:

Certified Capacity:PRU 52300

with Telepractice Designation - [all of these beds may be used for the provision of inpatient rehabilitation services, as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11707_HelioH.pdf

Certificate Number: 230912069

Suite 101, 1st Floor, 329 North Salina Street, Syracuse, New York 13203

Effective: 10/01/2020 9/30/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 250Service Type:

Program Name:

Certified Capacity:PRU 53067

with Telepractice Designation [with ancillary withdrawal services for up to 25 patients]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12069_HelioH.pdf

Certificate Number: 220312136

Building 1 - Wings E, F & G, 249 Glenwood Road, , Binghamton, New York 13905

Effective: 07/03/2020 3/31/2022

Program Location:

Amendment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 30Service Type:

Program Name:

Certified Capacity:PRU 53211

[up to 20 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12136_HelioH.pdf

January 31, 2022 Page 94 of 227

Certificate Number: 231012174

Suite 100, 1213 Court Street, , Utica, New York 13502

Effective: 11/01/2020 10/31/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 250Service Type:

Program Name:

Certified Capacity:PRU 53296

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12174_HelioH.pdf

Certificate Number: 220712192

Harriet May Mills House, 1074 West Genesee Street, , Syracuse, New York 13204

Effective: 08/01/2021 7/31/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

The Women's Halfway House

12Service Type:

Program Name:

Certified Capacity:PRU 53348

with Telepractice Designation [for women]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12192_HelioH.pdf

Certificate Number: 210712193

168 Lincoln Avenue, , Syracuse, New York 13204

Effective: 10/21/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Lincoln House

30Service Type:

Program Name:

Certified Capacity:PRU 53349

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Certificate Number: 220712194

3606 James Street, , Syracuse, New York 13206

Effective: 08/01/2021 7/31/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

The Men's Halfway House

16Service Type:

Program Name:

Certified Capacity:PRU 53350

with Telepractice Designation [for men]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12194_HelioH.pdf

Certificate Number: 230212203

Building 1 - Wings E, F & G, 249 Glenwood Road, , Binghamton, New York 13905

Effective: 03/01/2021 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Helio Health Binghamton Inpatient Rehabilitation

20Service Type:

Program Name:

Certified Capacity:PRU 53359

[up to 20 of these beds may be used for the provision of Section 816.7 medically supervised inpatient withdrawal & stabilization services, as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12203_HelioH.pdf

January 31, 2022 Page 95 of 227

Certificate Number: 201212225

1st and 2nd Floor, 4567 Crossroads Park Drive, Liverpool, New York 13088

Effective: 10/21/2020 12/31/2020

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Elements

75Service Type:

Program Name:

Certified Capacity:PRU 53444

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12225_HelioH.pdf

Certificate Number: 211212248

500 Whitesboro Street , , Utica, New York 13502

Effective: 12/17/2021 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53523

with Telepractice and Problem Gambling Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12248_HelioH.pdf

Certificate Number: 211212250

Basement, 1st, & 2nd Floo, 500 Whitesboro Street, , Utica, New York 13502

Effective: 01/21/2021 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820) 44Service Type:

Program Name:

Certified Capacity:PRU 53528

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12250_HelioH.pdf

Certificate Number: 220312263

1st Floor & Annex B, 1350 University Avenue, , Rochester, New York 14607

Effective: 04/30/2021 3/31/2022

Program Location:

Establishment Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 10Service Type:

Program Name:

Certified Capacity:PRU 53559

with Telepractice Designation - [all of these beds may be used for the provision of medically supervised withdrawal & stabilization services, as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12263_HelioH.pdf

Certificate Number: 220512268

121-125 Green Street, , Syracuse, New York 13203

Effective: 06/07/2021 5/31/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Green Street Residential Rehabilitation

30Service Type:

Program Name:

Certified Capacity:PRU 53443

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12268_HelioH.pdf

January 31, 2022 Page 96 of 227

Certificate Number: 220712270

Suite 400, 329 North Salina Street, , Syracuse, New York 13203

Effective: 08/01/2021 7/31/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820) 80Service Type:

Program Name:

Certified Capacity:PRU 53565

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Hispanic Counseling Center, Inc.

Ms. Gladys Serrano, Chief Executive Officer

344 Fulton Avenue, Hempstead, NY 11550

Provider Number: 33160

Administrative Office:

Telephone - (516)-538-2613 Ext 227

Certificate Number: 231110806

1st & 2nd Floors, 344 Fulton Avenue, Hempstead, New York 11550

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50972

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10806_Hispan.pdf

HONOR ehg, Inc.

Mr. Christopher Molinelli, Executive Director

Suite 300, 38 Seward Avenue, Middletown, NY 10940

Provider Number: 34210

Administrative Office:

Telephone - (845)-343-7115

Certificate Number: 200212012

Suite 300, 1st Floor, 38 Seward Avenue, Middletown, New York 10940

Effective: 10/01/2019 2/29/2020

Program Location:

Conditional Certificate Anticipated Recert Review:

Residential Services (820) 20Service Type:

Program Name:

Certified Capacity:PRU 53463

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12012_HONORe.pdf

Hope For Youth, Inc.

David J. Hegarty Ph.D., Executive Director

201 Dixon Avenue, Amityville, NY 11701

Provider Number: 16320

Administrative Office:

Telephone - (631)-782-6501 Ext 111

Certificate Number: 230611767

201 Dixon Avenue, Amityville, New York 11701

Effective: 07/01/2021 6/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52608

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11767_HopeFo.pdf

January 31, 2022 Page 97 of 227

Hope House, Inc.

Mr. Kevin M. Connally, Executive Director

573 Livingston Avenue, Albany, NY 12206

Provider Number: 35300

Administrative Office:

Telephone - (518)-482-4673 Ext 216

Certificate Number: 210510809

3rd Floor, 747 Madison Avenue, Albany, New York 12208

Effective: 09/04/2020 5/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51291

with Telepractice Designation

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

1st & 2nd Floors, 890 Madison Avenue, , Albany, New York 12208

Effective: 10/15/2018 12/31/2018

Program Location:

Amendment Anticipated Recert Review:

Community Residential (819)

Hope House Women and Children's Program

21Service Type:

Program Name:

Certified Capacity:PRU 51834

and up to 12 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11303_HopeHo.pdf

Certificate Number: 200612198

2 Holland Avenue, , Albany, New York 12209

Effective: 07/01/2019 6/30/2020

Program Location:

Establishment Anticipated Recert Review:

Supportive Living (819)

Hope House Next Step

6Service Type:

Program Name:

Certified Capacity:PRU 53379

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12198_HopeHo.pdf

Certificate Number: 200612199

2 Holland Avenue, , Albany, New York 12209

Effective: 07/01/2019 6/30/2020

Program Location:

Establishment Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Hope House Next Step

20Service Type:

Program Name:

Certified Capacity:PRU 53380

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12199_HopeHo.pdf

Certificate Number: 240512205

261 North Pearl Street, , Albany, New York 12207

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Bette Center

35Service Type:

Program Name:

Certified Capacity:PRU 53446

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12205_HopeHo.pdf

January 31, 2022 Page 98 of 227

Certificate Number: 210112215

577 Livingston Avenue, , Albany, New York 12206

Effective: 02/24/2020 1/31/2021

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Women's Recovery Program

20Service Type:

Program Name:

Certified Capacity:PRU 53471

[for women]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12215_HopeHo.pdf

Certificate Number: 220412256

1724 Fifth Avenue , , Troy, New York 12180

Effective: 05/01/2021 4/30/2022

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)

Hope House Outpatient Clinic Troy

Service Type:

Program Name:

Certified Capacity:PRU 53454

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12256_HopeHo.pdf

Certificate Number: 220412257

559-565 Sixth Avenue, , Troy, New York 12182

Effective: 05/01/2021 4/30/2022

Program Location:

Establishment Anticipated Recert Review:

Supportive Living (819)

Hope House Troy Supportive Living

17Service Type:

Program Name:

Certified Capacity:PRU 53456

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12257_HopeHo.pdf

Certificate Number: 220412258

106-108 Ninth Street, , Troy, New York 12180

Effective: 05/01/2021 4/30/2022

Program Location:

Establishment Anticipated Recert Review:

Community Residential (819)

Hope House Elizabeth House

16Service Type:

Program Name:

Certified Capacity:PRU 53455

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12258_HopeHo.pdf

Certificate Number: 220512273

573 Livingston Avenue, , Albany, New York 12206

Effective: 06/01/2021 5/31/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Men's Recovery Program

20Service Type:

Program Name:

Certified Capacity:PRU 53551

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12273_HopeHo.pdf

Horizon Health Services, Inc.

Ms. Anne D. Constantino, President and Chief Executive Officer

55 Dodge Road, Getzville, NY 14068

Provider Number: 11130

Administrative Office:

Telephone - (716)-831-2700

January 31, 2022 Page 99 of 227

Certificate Number: 220310811

3020 Bailey Avenue, Buffalo, New York 14215

Effective: 04/01/2020 3/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Bailey Recovery Center

0Service Type:

Program Name:

Certified Capacity:PRU 50031

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10811_Horizo.pdf

Certificate Number: 230910812

1370 Niagara Falls Boulevard, Tonawanda, New York 14150

Effective: 10/01/2020 9/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Boulevard Recovery Center

0Service Type:

Program Name:

Certified Capacity:PRU 50029

with Telepractice Designation

55 Dodge Road , Getzville, NY 14068

Additional Location(s) At:

37 Niagara Street, Tonawanda, NY 14150

Additional Location(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10812_Horizo.pdf

Certificate Number: 230210814

Suite 350, 699 Hertel Avenue, Buffalo, New York 14207

Effective: 03/01/2020 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 51197

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10814_Horizo.pdf

Certificate Number: 240310815

77 Broadway Street, Buffalo, New York 14203

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 51198

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10815_Horizo.pdf

Certificate Number: 221210821

637 Davison Road, Lockport, New York 14094

Effective: 01/01/2020 12/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Lockport Recovery Center

0Service Type:

Program Name:

Certified Capacity:PRU 51804

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10821_Horizo.pdf

January 31, 2022 Page 100 of 227

Certificate Number: 230111662

2400 Pine Avenue, Niagara Falls, New York 14301

Effective: 12/31/2020 1/31/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Pine Avenue Recovery Center

0Service Type:

Program Name:

Certified Capacity:PRU 52194

with Telepractice Designation

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

2563 Union Road, , Cheektowaga, New York 14227

Effective: 06/01/2021 5/31/2023

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Outpatient Service (822)

Union Losson Recovery Center

0Service Type:

Program Name:

Certified Capacity:PRU 52214

with Telepractice Designation

Integrated Outpatient Services - MH

Union Losson Recovery Center

0Service Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11680_Horizo.pdf

Certificate Number: 240411690

314 Ellicott Street, , Batavia, New York 14020

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Outpatient Service (822)

Batavia Recovery Center

0Service Type:

Program Name:

Certified Capacity:PRU 52225

with Telepractice Designation

Integrated Outpatient Services - MH

Batavia Recovery Center

0Service Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11690_Horizo.pdf

Certificate Number: 220911714

6495 Transit Road, East Amherst, New York 14051

Effective: 10/01/2019 9/30/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

East Amherst Family Recovery Center

0Service Type:

Program Name:

Certified Capacity:PRU 52529

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11714_Horizo.pdf

Certificate Number: 220111772

3345 Southwestern Boulevard, , Orchard Park, New York 14127

Effective: 04/25/2019 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52617

with Telepractice Designation

January 31, 2022 Page 101 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11772_Horizo.pdf

Horizon Village, Inc.

Ms. Anne D. Constantino, President /CEO

55 Dodge Rd., Getzville, NY 14068

Provider Number: 25820

Administrative Office:

Telephone - (716)-831-2700

Certificate Number: 220211820

1st Floor, 291 Elm Street, Buffalo, New York 14203

Effective: 07/10/2020 2/28/2022

Program Location:

Amendment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

Terrace House

10Service Type:

Program Name:

Certified Capacity:PRU 52730

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11820_Horizo.pdf

Certificate Number: 181212030

6302 Inducon Drive East, Sanborn, New York 14132

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Residential Services (820)

Delta Village

25Service Type:

Program Name:

Certified Capacity:PRU 53487

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12030_Horizo.pdf

Certificate Number: 181212039

6301 Inducon Drive East, Sanborn, New York 14132

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Residential Services (820)

Horizon Village

50Service Type:

Program Name:

Certified Capacity:PRU 53485

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12039_Horizo.pdf

Certificate Number: 181212040

6331 Inducon Drive East, Sanborn, New York 14132

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Residential Services (820)

Freedom Village

25Service Type:

Program Name:

Certified Capacity:PRU 53486

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12040_Horizo.pdf

Certificate Number: 240112044

1st and 2nd Floors, 291 Elm Street, Buffalo, New York 14203

Effective: 02/01/2021 1/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Terrace House

58Service Type:

Program Name:

Certified Capacity:PRU 53484

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

January 31, 2022 Page 102 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12044_Horizo.pdf

Certificate Number: 190912159

6298 Inducon Drive East, Sanborn, New York 14132

Effective: 10/01/2018 9/30/2019

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Aurora Village

25Service Type:

Program Name:

Certified Capacity:PRU 53488

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12159_Horizo.pdf

Hornell Area Concern for Youth, Inc.

Ms. Susan Hooker, Executive Director

76 East Main Street, Hornell, NY 14843

Provider Number: 397

Administrative Office:

Telephone - (607)-324-0808

Certificate Number: 220611989

Room 1, 1st Floor, 76 East Main Street, Hornell, New York 14843

Effective: 07/01/2019 6/30/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90586

Canisteo-Greenwood Central School District, Ground Floor, Rooms 109 & 153, 120 Greenwood Street, Canisteo, NY 14823

Other Service Site(s) At:

Canisteo-Greenwood Central School District, Psych. Room, 1st Floor, Room 178B, 84 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:

Intermediate School, 1st Floor, Nurse's Office, Room 108, 71 Buffalo Street, Hornell, NY 14843

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:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11989_Hornel.pdf

Hospitality House T.C., Inc.

Mr Young Do, Executive Director

271 Central Avenue, Albany, NY 12206

Provider Number: 170

Administrative Office:

Telephone - (518)-434-6468 Ext 106

Certificate Number: 211112048

271 Central Avenue, , Albany, New York 12206

Effective: 12/28/2020 11/30/2021

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820) 45Service Type:

Program Name:

Certified Capacity:PRU 53452

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12048_Hospit.pdf

January 31, 2022 Page 103 of 227

Housing Works, Inc. as Sponsor, Bailey House, Inc. as Operator

Mr. Andrew Coamey, Executive Director

2nd Floor, 120 Lawrence Street, Brooklyn, NY 11201

Provider Number: 1738

Administrative Office:

Telephone - (347)-473-7400

Certificate Number: 221211962

The Rand Harlan Center for Housing, Wellness and Community, 3rd Floor, 1751 Park Avenue, New York, New York 10035

Effective: 06/05/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52933

with Telepractice Designation

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

Mr. Charles A. King, Chief Executive Officer

57 Willoughby Street, Brooklyn, NY 11201

Provider Number: 48960

Administrative Office:

Telephone - (347)-473-7407 Ext 7401

Certificate Number: 230911997

Basement & 1st Floor, 2640 Pitkin Avenue, , Brooklyn, New York 11208

Effective: 10/01/2020 9/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52958

with Telepractice Designation

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

Ms. Anne K. Nolon MPH, President and Chief Executive Officer

1037 Main Street, Peekskill, NY 10566

Provider Number: 34370

Administrative Office:

Telephone - (914)-734-8600

Certificate Number: 230110933

Peekskill Area Health Center, Rooms 226 - 234, Basement & 2nd Floor, 1037 Main Street, Peekskill, New York 10566

Effective: 10/06/2020 1/31/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50979

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10933_Hudson.pdf

Certificate Number: 221112171

2400 Linden Boulevard, , Brooklyn, New York 11208

Effective: 10/06/2020 11/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Alpha School 822 Program

Service Type:

Program Name:

Certified Capacity:PRU 53298

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12171_Hudson.pdf

January 31, 2022 Page 104 of 227

Certificate Number: 211212172

6th Floor, 56 Bay Street, , Staten Island, New York 10301

Effective: 10/06/2020 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Bay Street 822 Program

0Service Type:

Program Name:

Certified Capacity:PRU 53300

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12172_Hudson.pdf

Huntington Youth Bureau Youth Development Research Institute, Inc.

Ms. Maria Georgiou, Executive Director

2nd Floor, 423 Park Avenue, Huntington, NY 11743

Provider Number: 172

Administrative Office:

Telephone - (631)-351-3061

Certificate Number: 220811518

3rd Floor, 423 Park Avenue, Huntington, New York 11743

Effective: 07/03/2020 8/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 992

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11518_Huntin.pdf

Huther-Doyle Memorial Institute, Inc.

Ms. Kelly Reed, President/CEO

360 East Avenue, Rochester, NY 14604

Provider Number: 32707

Administrative Office:

Telephone - (585)-325-5100 Ext 3501

Certificate Number: 221110827

1st & 2nd Floors, 360 East Avenue, Rochester, New York 14604

Effective: 12/01/2020 11/30/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Discovery

Service Type:

Program Name:

Certified Capacity:PRU 6013

with Telepractice Designation [with ancillary withdrawal services

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10827_Huther.pdf

Immigrant Social Services, Inc.

Ms. Beatrice Chen, Executive Director

137 Henry Street, New York, NY 10002

Provider Number: 889

Administrative Office:

Telephone - (212)-571-1840 Ext 100

Certificate Number: 230211974

Basement, 1st & 2nd Floor, 137 Henry Street, New York, New York 10002

Effective: 03/01/2021 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90744

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

January 31, 2022 Page 105 of 227

Innovative Health Systems, Inc.

Mr. Abe Hikind, CEO

2nd Floor, 20 Church Street, White Plains, NY 10601

Provider Number: 32417

Administrative Office:

Telephone - (914)-683-8050

Certificate Number: 210610830

2nd Floor, 20 Church Street, White Plains, New York 10601

Effective: 07/03/2020 6/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50978

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52247

with Telepractice Designation

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)

Stephen Gersten Psy.D., CEO

1623 Kings Highway, Brooklyn, NY 11229

Provider Number: 15410

Administrative Office:

Telephone - (929)-273-7601 Ext 427

Certificate Number: 211212253

1664 East 14th Street, , Brooklyn, New York 11229

Effective: 01/07/2021 12/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53511

with Telepractice Designation

1117 Eastern Parkway, Brooklyn, NY 11213

Additional Location(s) At:

6th & 7th Floors, 2846 Stillwell Avenue, Brooklyn, NY 11224

Additional Location(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12253_Interb.pdf

Inter-Care LTD.

Mr. Nicholas Lessa, Chief Executive Officer

7 West Cross Street, Hawthorne, NY 10532

Provider Number: 16640

Administrative Office:

Telephone - (914)-437-6800 Ext 212

Certificate Number: 211110833

4th Floor, 51 East 25th Street, , New York, New York 10010

Effective: 09/30/2021 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51154

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10833_InterC.pdf

January 31, 2022 Page 106 of 227

Certificate Number: 211111882

1st Floor, 5-7 West Cross Street, , Hawthorne, New York 10532

Effective: 05/11/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52852

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11882_InterC.pdf

Inwood Community Services, Inc.

Charles Corliss Ph.D., Executive Director

3rd Floor, 651 Academy Street, New York, NY 10034

Provider Number: 31470

Administrative Office:

Telephone - (212)-942-0043 Ext 133

Certificate Number: 220810836

2nd and 3rd Floors, 651 Academy Street, New York, New York 10034

Effective: 09/09/2020 8/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50985

with Telepractice Designation

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

Ms. Jessica Janssen, CEO

334 West State Street, P.O. Box 789, Ithaca, NY 14850

Provider Number: 10930

Administrative Office:

Telephone - (315)-730-4634

Certificate Number: 210212037

6621 Route 227, Trumansburg, New York 14886

Effective: 03/01/2020 2/28/2021

Program Location:

Conditional Certificate Anticipated Recert Review:

Residential Services (820) 60Service Type:

Program Name:

Certified Capacity:PRU 53017

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12037_Ithaca.pdf

Certificate Number: 230912202

334 West State Street, , Ithaca, New York 14850

Effective: 11/22/2021 9/30/2023

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 50Service Type:

Program Name:

Certified Capacity:PRU 53341

with Telepractice Designation

Capacity Lifted

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53607

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12202_Ithaca.pdf

January 31, 2022 Page 107 of 227

JCTOD Outreach, Inc. d/b/a Johnson Park Center

RevDr Maria A. Scates D.D., CEO/Founder

26 Johnson Park, P.O. Box 160, Utica, NY 13503

Provider Number: 48430

Administrative Office:

Telephone - (315)-734-9608

Certificate Number: 181211807

19 Johnson Park, Utica, New York 13501

Effective: 01/01/2018 12/31/2018

Program Location:

Conditional Certificate Anticipated Recert Review:

Supportive Living (819) 6Service Type:

Program Name:

Certified Capacity:PRU 52694

and up to 14 beds for children

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

Mr. Gerard Ilaria, Executive Director

Department of Public Health Programs Administration, Room 3-305, 25th, 641 Lexington Avenue, New York, NY 10022

Provider Number: 43750

Administrative Office:

Telephone - (212)-746-5917

Certificate Number: 231111059

9th Floor, 56 West 45th Street, New York, New York 10036

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Midtown Center for Treatment and Research

Service Type:

Program Name:

Certified Capacity:PRU 6098

with Telepractice Designation

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

Mr Robert Degiarde, Executive Director

233-235 Lafayette Street, New York, NY 10012

Provider Number: 45580

Administrative Office:

Telephone - (212)-226-6263

Certificate Number: 230111804

1st & 2nd Floors, 233-235 Lafayette Street, New York, New York 10012

Effective: 09/01/2020 1/31/2023

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 600Service Type:

Program Name:

Certified Capacity:PRU 52692

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11804_Lafaye.pdf

Larchmont-Mamaroneck Narcotics Guidance Council

Mark Levy Ph.D., Executive Director

234 Stanley Avenue, Mamaroneck, NY 10543

Provider Number: 447

Administrative Office:

Telephone - (914)-698-7549

Certificate Number: 240412000

1st Floor, 234 Stanley Avenue, Mamaroneck, New York 10543

Effective: 08/10/2021 4/30/2024

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90588

with Telepractice Designation

January 31, 2022 Page 108 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12000_Larchm.pdf

LaSalle School

Mr. David C. Wallace, Chief Executive Officer

391 Western Avenue, Albany, NY 12203

Provider Number: 12400

Administrative Office:

Telephone - (518)-242-4731 Ext 218

Certificate Number: 240110842

Admin. Building, Burke Hall, Hanner Chapel, Cultural Center, Gym, Cafeteria, & Lobby Conference, 391 Western Avenue, Rooms 101, 204, 205 & 206, Albany, New York 12203

Effective: 02/01/2021 1/31/2024

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 5469

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10842_LaSall.pdf

Certificate Number: 220812276

391 Western Avenue, , Albany, New York 12203

Effective: 09/23/2021 8/31/2022

Program Location:

Establishment Anticipated Recert Review:

Community Psychiatric Support & Treatment (CPST)Service Type:

Program Name:

Certified Capacity:PRU 53590

Other Licensed PractitionersService Type:

Program Name:

Certified Capacity:PRU 53588

Psychosocial Rehabilitation (PSR)Service Type:

Program Name:

Certified Capacity:PRU 53589

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12276_LaSall.pdf

Lesbian and Gay Community Services Center Inc.

Ms. Glennda Testone, Executive Director

208 West 13th Street, New York, NY 10011

Provider Number: 31450

Administrative Office:

Telephone - (212)-620-7310 Ext 419

Certificate Number: 220711628

1st Floor, 208 West 13th Street, New York, New York 10011

Effective: 09/04/2020 7/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Center CARE Recovery

Service Type:

Program Name:

Certified Capacity:PRU 52109

with Telepractice Designation

Outpatient Service (822)

Center CARE Recovery

Service Type:

Program Name:

Certified Capacity:PRU 52950

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11628_Lesbia.pdf

January 31, 2022 Page 109 of 227

Certificate Number: 230211972

Annex, 208 West 13th Street, New York, New York 10011

Effective: 03/01/2020 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90778

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11972_Lesbia.pdf

Lexington Center for Recovery, Inc.

Adrienne Marcus Ph.D., Chief Executive Officer

2875 Route 35, Katonah, NY 10536

Provider Number: 34200

Administrative Office:

Telephone - (914)-666-0191 Ext 1006

Certificate Number: 230710575

24 Smith Avenue, Mount Kisco, New York 10549

Effective: 08/01/2021 7/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Mount Kisco Clinic

Service Type:

Program Name:

Certified Capacity:PRU 50818

[with ancillary withdrawal services] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10575_Lexing.pdf

Certificate Number: 210911340

41 Page Park Drive, , Poughkeepsie, New York 12603

Effective: 02/11/2019 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50577

with Telepractice Designation

Outpatient Rehabilitation Service (822)

Page Park Day Rehab. Program

40Service Type:

Program Name:

Certified Capacity:PRU 53580

with Telepractice Designation

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

Summerlin Plaza, Suites 201-204, 942 Route 376, Wappingers Falls, New York 12590

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 51777

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11341_Lexing.pdf

January 31, 2022 Page 110 of 227

Certificate Number: 240511461

2nd Floor, 3 Cottage Place, , New Rochelle, New York 10801

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50386

with Telepractice and Problem Gambling Designations

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51940

with Telepractice and Problem Gambling Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11461_Lexing.pdf

Certificate Number: 230211477

Suite 200, 41 Page Park Drive, , Poughkeepsie, New York 12603

Effective: 08/04/2020 2/28/2023

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 300Service Type:

Program Name:

Certified Capacity:PRU 391

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11477_Lexing.pdf

Certificate Number: 230211641

Suite 111, 100 Route 59, , Airmont, New York 10952

Effective: 08/09/2021 2/28/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52137

with Telepractice and Problem Gambling Designations

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52140

with Telepractice and Problem Gambling Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11641_Lexing.pdf

Certificate Number: 230111727

Samsondale Shopping Plaza, 45 South Route 9W, , West Haverstraw, New York 10993

Effective: 07/03/2020 1/31/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52154

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11727_Lexing.pdf

Certificate Number: 210311755

2nd Floor, 412 Main Street, , Poughkeepsie, New York 12601

Effective: 04/01/2019 3/31/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52586

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11755_Lexing.pdf

January 31, 2022 Page 111 of 227

Certificate Number: 231111794

Suite D, 706 Executive Boulevard, Valley Cottage, New York 10989

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822)

Rockland Medication Assisted Treatment Program

250Service Type:

Program Name:

Certified Capacity:PRU 52646

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11794_Lexing.pdf

Certificate Number: 221011862

3 Corporate Drive, , Peekskill, New York 10566

Effective: 11/01/2019 10/31/2022

Program Location:

Renewal Anticipated Recert Review:

Opioid Full Agonist Treatment Program (822) 235Service Type:

Program Name:

Certified Capacity:PRU 52801

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11862_Lexing.pdf

Certificate Number: 211111883

3 Corporate Drive, , Peekskill, New York 10566

Effective: 09/19/2019 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

LCR Peekskill Clinic

0Service Type:

Program Name:

Certified Capacity:PRU 52800

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11883_Lexing.pdf

Liberty Resources, Inc.

Mr. Carl M. Coyle, Chief Executive Officer

Suite 200, 6723 Towpath Road, East Syracuse, NY 13507

Provider Number: 50660

Administrative Office:

Telephone - (315)-425-1004 Ext 255

Certificate Number: 190710205

239 Broad Street, Oneida, New York 13421

Effective: 04/25/2019 7/31/2019

Program Location:

Amendment Anticipated Recert Review:

Supportive Living (819)

The Next Step Apartment Program

30Service Type:

Program Name:

Certified Capacity:PRU 51601

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10205_Libert.pdf

Certificate Number: 181210206

239 Broad Street, Oneida, New York 13421

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 18Service Type:

Program Name:

Certified Capacity:PRU 51121

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10206_Libert.pdf

January 31, 2022 Page 112 of 227

Certificate Number: 220112206

1045 James Street, , Syracuse, New York 13203

Effective: 02/01/2021 1/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)

Liberty Resources Integrated Health Care

Service Type:

Program Name:

Certified Capacity:PRU 53457

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12206_Libert.pdf

Long Beach Reach, Inc.

Joseph M. Smith Ph.D., Executive Director

Suite 200, 3rd Floor, 2-12 West Park Avenue, Long Beach, NY 11561

Provider Number: 190

Administrative Office:

Telephone - (516)-889-2332

Certificate Number: 220910851

2nd & 3rd Floors, 2-12 West Park Avenue, Long Beach, New York 11561

Effective: 10/01/2020 9/30/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7051

with Telepractice Designation

225 Main Street, Port Washington, NY 11050

Additional Location(s) At:

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:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10851_LongBe.pdf

Long Island Center for Recovery, Inc.

Ms. Shawn Hamilton, Chief Executive Officer

320 West Montauk Highway, Hampton Bays, NY 11946

Provider Number: 25850

Administrative Office:

Telephone - (631)-728-3100

Certificate Number: 220710071

320 West Montauk Highway, Hampton Bays, New York 11946

Effective: 08/01/2019 7/31/2022

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 10Service Type:

Program Name:

Certified Capacity:PRU 51759

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10071_LongIs.pdf

Certificate Number: 240411373

320 West Montauk Highway, Hampton Bays, New York 11946

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 40Service Type:

Program Name:

Certified Capacity:PRU 51713

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11373_LongIs.pdf

January 31, 2022 Page 113 of 227

Long Island Consultation Center, Inc.

Ms. Elaine Lederer, Executive Director

Suite 222, 2nd Floor, 91-31 Queens Boulevard, Elmhurst, NY 11373

Provider Number: 16190

Administrative Office:

Telephone - (718)-896-3400 Ext 118

Certificate Number: 240410852

2nd Floor, 91-31 Queens Boulevard, Elmhurst, New York 11373

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50330

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10852_LongIs.pdf

Long Island Treatment Center LLC

Mr. Jesse Reuter, CEO

100 W. Nicholai Street, Hicksville, NY 11801

Provider Number: 51710

Administrative Office:

Telephone - (718)-483-2953

Certificate Number: 220912285

100 W. Nicholai Street, , Hicksville, New York 11801

Effective: 12/21/2021 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Long Island Treatment Center

Service Type:

Program Name:

Certified Capacity:PRU 53561

with Telepractice Designation

Outpatient Rehabilitation Service (822)

Long Island Treatment Center

Service Type:

Program Name:

Certified Capacity:PRU 53591

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12285_LongIs.pdf

The Lower East Side Service Center, Inc.

Ms. Valerie C. Walters, President and Chief Executive Officer

Suite 305, 3rd Floor, 80 Maiden Lane, New York, NY 10038

Provider Number: 23720

Administrative Office:

Telephone - (212)-566-7719

Certificate Number: 211110360

1st, 2nd, 4th and 5th Floors, 46 East Broadway, New York, New York 10002

Effective: 07/10/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 490Service Type:

Program Name:

Certified Capacity:PRU 644

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10360_LowerE.pdf

Certificate Number: 211210361

46 East Broadway (4th & 5th Floors), 62 East Broadway (1st & 2nd Floors), New York, New York 10002

Effective: 01/01/2021 12/31/2021

Program Location:

Conditional Certificate Anticipated Recert Review:

Opioid Treatment Program (822)

Clinic III

380Service Type:

Program Name:

Certified Capacity:PRU 646

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10361_LowerE.pdf

January 31, 2022 Page 114 of 227

Certificate Number: 211110362

7 Gouverneur Slip East, New York, New York 10002

Effective: 06/01/2021 11/30/2021

Program Location:

Conditional Certificate Anticipated Recert Review:

Residential Opioid Treatment Program (822) 100Service Type:

Program Name:

Certified Capacity:PRU 311

[for PRU #52063 only] with Telepractice Designation

Residential Opioid Treatment Program (822) 43Service Type:

Program Name:

Certified Capacity:PRU 3096

[for PRU #52063 only] with Telepractice Designation

Residential Opioid Treatment Program (822) 10Service Type:

Program Name:

Certified Capacity:PRU 52063

[for PRU #52063 only] with Telepractice Designation

and up to 8 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10362_LowerE.pdf

Certificate Number: 210511062

4th - 7th Floors, 46 East Broadway, New York, New York 10002

Effective: 07/10/2020 5/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7294

with Telepractice Designation

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

Howard K. Hitzel PsyD, President

Suite 300, 255 Delaware Avenue, Buffalo, NY 14202

Provider Number: 50250

Administrative Office:

Telephone - (716)-842-0440 Ext 112

Certificate Number: 210712081

3176 Abbott Road, , Orchard Park, New York 14127

Effective: 08/01/2018 7/31/2021

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)

Abbott Corners Addiction Services

Service Type:

Program Name:

Certified Capacity:PRU 53114

with Telepractice Designation [with ancillary withdrawal 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

1st and 2nd Floors, 951-955 Niagara Street, Buffalo, New York 14213

Effective: 01/01/2018 5/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:OMH Host

Outpatient Service (822)

Lower West Side Addictions Services

Service Type:

Program Name:

Certified Capacity:PRU 53113

with Telepractice Designation [with ancillary withdrawal 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

January 31, 2022 Page 115 of 227

Certificate Number: 220912162

3176 Abbott Road, , Orchard Park, New York 14127

Effective: 02/03/2020 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Abbott Corners Addiction Services OTP

99Service Type:

Program Name:

Certified Capacity:PRU 53276

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12162_LSCAGr.pdf

Certificate Number: 210812191

1st & 2nd Floors, 232-262 Hempstead Avenue, , Buffalo, New York 14215

Effective: 09/01/2020 8/31/2021

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

The Lighthouse -Women's Residential Treatment Program

22Service Type:

Program Name:

Certified Capacity:PRU 53458

with Telepractice Designation

and up to 30 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12191_LSCAGr.pdf

Medical Arts Sanitarium, Inc.

Mr. Thomas Puzo, Chief Executive Officer

159-05 Union Turnpike, Fresh Meadows, NY 11366

Provider Number: 81770

Administrative Office:

Telephone - (718)-906-6700 Ext 3103

Certificate Number: 221010239

Rhinebeck Lodge, Building 1, 2nd Floor, 500 Milan Hollow Road, Rhinebeck, New York 12572

Effective: 11/01/2019 10/31/2022

Program Location:

Renewal Anticipated Recert Review:

d/b/a Cornerstone of Rhinebeck

Inpatient Rehabilitation Service ( 818)

Cornerstone of Rhinebeck, NY

93Service Type:

Program Name:

Certified Capacity:PRU 50486

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.]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10239_Medica.pdf

Certificate Number: 221010241

2nd Floors, Basement, 1st &, 159-05 Union Turnpike, Fresh Meadows, New York 11366

Effective: 11/24/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

d/b/a Cornerstone of Medical Arts Center

Inpatient Rehabilitation Service ( 818) 60Service Type:

Program Name:

Certified Capacity:PRU 51379

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]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10241_Medica.pdf

January 31, 2022 Page 116 of 227

Certificate Number: 221111438

Rhinebeck Lodge, Building 1, Ground Floor, 500 Milan Hollow Road, Rhinebeck, New York 12572

Effective: 12/01/2019 11/1/2022

Program Location:

Renewal Anticipated Recert Review:

d/b/a Cornerstone of Rhinebeck

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

Cornerstone of Rhinebeck, NY

6Service Type:

Program Name:

Certified Capacity:PRU 7163

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.]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11438_Medica.pdf

Certificate Number: 221111440

4th Floors, Basement, 3rd &, 159-05 Union Turnpike, Fresh Meadows, New York 11366

Effective: 11/24/2020 11/30/2022

Program Location:

Amendment Anticipated Recert Review:

d/b/a Cornerstone of Medical Arts Center

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 116Service Type:

Program Name:

Certified Capacity:PRU 9

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]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11440_Medica.pdf

Mental Health America of Dutchess County, Inc.,

Mr. Andrew O'Grady, CEO

253 Mansion Street, Poughkeepsie, NY 12601

Provider Number: 14020

Administrative Office:

Telephone - (845)-473-2500

Certificate Number: 220812278

Route 376, 2103 New Hackensack Road, , Poughkeepsie, New York 12603

Effective: 09/20/2021 8/31/2022

Program Location:

Establishment Anticipated Recert Review:

Community Residential (819)

Dowling House

12Service Type:

Program Name:

Certified Capacity:PRU 53592

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12278_Mental.pdf

Certificate Number: 220812279

230 Church Street, , Poughkeepsie, New York 12601

Effective: 09/20/2021 8/31/2022

Program Location:

Establishment Anticipated Recert Review:

Community Residential (819)

Bolger House

24Service Type:

Program Name:

Certified Capacity:PRU 53593

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12279_Mental.pdf

Certificate Number: 220812280

24 West Cottage Road, , Poughkeepsie, New York 12601

Effective: 09/20/2021 8/31/2022

Program Location:

Establishment Anticipated Recert Review:

Community Residential (819)

Florence Manor

24Service Type:

Program Name:

Certified Capacity:PRU 53594

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12280_Mental.pdf

January 31, 2022 Page 117 of 227

Certificate Number: 220812281

1st Floor, 51 Cannon Street, , Poughkeepsie, New York 12601

Effective: 09/20/2021 8/31/2022

Program Location:

Establishment Anticipated Recert Review:

Medically Monitored Withdrawal & Stabilization Services (816.9) 12Service Type:

Program Name:

Certified Capacity:PRU 53595

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12281_Mental.pdf

Mental Health Association in Fulton and Montgomery Counties, Inc.

Ms. Janine Dykeman, Executive Director

307-309 Meadow Street, Johnstown, NY 12095

Provider Number: 24020

Administrative Office:

Telephone - (518)-762-5332

Certificate Number: 181211773

26 Phillips Street, Amsterdam, New York 12010

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Lighthouse

12Service Type:

Program Name:

Certified Capacity:PRU 52620

and up to 6 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11773_Mental.pdf

Mental Health Providers of Western Queens, Inc.

James T. McQuade Ph.D., Executive Director

2nd Floor, 40-23 62nd Street, Woodside, NY 11377

Provider Number: 16140

Administrative Office:

Telephone - (718)-898-5085

Certificate Number: 210910867

4th Floor, 62-07 Woodside Avenue, Woodside, New York 11377

Effective: 07/10/2020 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51264

with Telepractice Designation

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

Suite 2A, 2nd Floor, 37-08 91st Street, Jackson Heights, New York 11372

Effective: 08/10/2021 3/31/2024

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90863

with Telepractice Designation

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

Mr. Bruce C. Nisbet, Chief Executive Officer

227 Thorn Avenue, P.O. Box 631, Orchard Park, NY 14127

Provider Number: 50240

Administrative Office:

Telephone - (716)-662-2040

January 31, 2022 Page 118 of 227

Certificate Number: 210910870

, New York

Effective: 09/09/2021 9/30/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)

South Buffalo Counseling Center

Service Type:

Program Name:

Certified Capacity:PRU 50394

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10870_Mental.pdf

Certificate Number: 210910871

, New York

Effective: 06/01/2019 9/30/2021

Program Location:

Amendment/Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50393

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

1280 Main Street, , Buffalo, New York 14209

Effective: 07/30/2021 9/30/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)

New Alternatives

Service Type:

Program Name:

Certified Capacity:PRU 5119

[with ancillary withdrawal services] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11522_Mental.pdf

Certificate Number: 210911751

34 North Main Street, , Warsaw, New York 14569

Effective: 06/01/2019 9/30/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52581

[with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11751_Mental.pdf

Mercy Medical Center

Mr. Peter Scaminaci, President

1000 North Village Avenue, Rockville Centre, NY 11570

Provider Number: 85030

Administrative Office:

Telephone - (516)-705-1100

Certificate Number: 240110608

506 Stewart Avenue, Garden City, New York 11530

Effective: 08/10/2021 1/31/2024

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)

Mercy Hospital Family Counseling Services

Service Type:

Program Name:

Certified Capacity:PRU 50360

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10608_MercyM.pdf

January 31, 2022 Page 119 of 227

Certificate Number: 220212244

95 Pine Street, , Freeport, New York 11520

Effective: 03/01/2021 2/28/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Mercy Hall

22Service Type:

Program Name:

Certified Capacity:PRU 53525

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12244_MercyM.pdf

Certificate Number: 220212245

526 Greengrove Avenue, , Uniondale, New York 11553

Effective: 03/01/2021 2/28/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Recovery House

22Service Type:

Program Name:

Certified Capacity:PRU 53526

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12245_MercyM.pdf

Certificate Number: 220212246

150 Buffalo Avenue, , Freeport, New York 11520

Effective: 03/01/2021 2/28/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

New Hope

30Service Type:

Program Name:

Certified Capacity:PRU 53527

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12246_MercyM.pdf

Metropolitan Center for Mental Health

Mr. Robert Basile, Executive Director

160 West 86th Street, New York, NY 10024

Provider Number: 16130

Administrative Office:

Telephone - (212)-362-8755

Certificate Number: 220111330

Basement, 1090 St. Nicholas Avenue, New York, New York 10033

Effective: 08/25/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Families and Individuals in Recovery (FAIR)

Service Type:

Program Name:

Certified Capacity:PRU 51729

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11330_Metrop.pdf

Metropolitan Community Services, Inc. d/b/a Journeys

Rabbi Sinai Halberstam, CEO

1049 38th Street, Brooklyn, NY 11219

Provider Number: 49320

Administrative Office:

Telephone - (718)-633-5328

Certificate Number: 230511996

1049 38th Street, Brooklyn, New York 11219

Effective: 06/01/2021 5/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52957

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11996_Metrop.pdf

January 31, 2022 Page 120 of 227

Mid-Erie Mental Health Services, Inc. d/b/a Endeavor Health Services

Ms. Elizabeth Mauro, Executive Director

Suite 400, 1st Floor, 1526 Walden Avenue, Cheektowaga, NY 14225

Provider Number: 50230

Administrative Office:

Telephone - (716)-895-6700 Ext 4051

Certificate Number: 220110875

Suite 400, 1526 Walden Avenue, Cheektowaga, New York 14225

Effective: 05/28/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50357

withTelepractice Designation [with ancillary withdrawal services]

Baker Victory Services Residential Treatment Facility-Admin. Bldg., 1st Floor, Conference Room/Counseling Office, 125 Martin Road, Lackawanna, NY 14218

Additional Location(s) At:

463 William Street, Buffalo, NY 14204

Additional Location(s) At:

Gateway-Longview, Inc. - Lynde School, Conference Room and Room 61, 6350 Main Street, Williamsville, NY 14221

Additional Location(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10875_MidEri.pdf

Certificate Number: 220110876

2nd Floor, 1131 Broadway, Buffalo, New York 14212

Effective: 05/28/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6428

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10876_MidEri.pdf

MIH Experience, LTD

Fernando Taveras M.D., Executive Director

1st Floor, 4580 Broadway, New York, NY 10040

Provider Number: 48730

Administrative Office:

Telephone - (212)-928-2020

Certificate Number: 210511982

1st Floor, 4580 Broadway, , New York, New York 10040

Effective: 11/19/2020 5/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52945

with Telepractice Designation [with ancillary withdrawal]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11982_MIHExp.pdf

The Monsignor Carr Institute

Mr. Dennis Walczyk, Chief Executive Officer

Administrative Offices, 741 Delaware Avenue, Buffalo, NY 14209

Provider Number: 24680

Administrative Office:

Telephone - (716)-218-1400 Ext 244

January 31, 2022 Page 121 of 227

Certificate Number: 220811063

Annex, 1st and 2nd Floors, 76 West Humboldt Parkway, Buffalo, New York 14214

Effective: 09/01/2020 8/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 5595

with Telepractice Designation

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

Ms. Jaccel Kouns, Executive Director/V.P. of Clinical Services

Montefiore Mount Vernon Hospital as Operator, Building #111, 12 N 7th Avenue, Mount Vernon, NY 10550

Provider Number: 80000

Administrative Office:

Telephone - (914)-631-6100

Certificate Number: 210911813

3 South Sixth Avenue, Mount Vernon, New York 10550

Effective: 09/09/2020 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 400Service Type:

Program Name:

Certified Capacity:PRU 52719

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11813_Montef.pdf

Montefiore Medical Center

Mr. Juan Martinez LCSW, Executive Director

Executive Suite, 1510 Waters Place, Bronx, NY 10461

Provider Number: 85420

Administrative Office:

Telephone - (718)-409-9450

Certificate Number: 210410454

1st & 2nd Floors, 2058 Jerome Avenue, Bronx, New York 10453

Effective: 08/03/2020 4/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 700Service Type:

Program Name:

Certified Capacity:PRU 420

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10454_Montef.pdf

Certificate Number: 231210455

1st Floor, 3550 Jerome Avenue, Bronx, New York 10467

Effective: 01/01/2021 12/31/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 350Service Type:

Program Name:

Certified Capacity:PRU 327

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10455_Montef.pdf

Certificate Number: 240711462

3rd Floor, 2058 Jerome Avenue, Bronx, New York 10453

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51981

with Telepractice Designation

January 31, 2022 Page 122 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11462_Montef.pdf

Certificate Number: 221011677

1st & 2nd Floors, 4401 Bronx Boulevard, Bronx, New York 10470

Effective: 08/05/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Wakefield Recovery Center

Service Type:

Program Name:

Certified Capacity:PRU 52212

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11677_Montef.pdf

Certificate Number: 210911871

804 East 138th Street, , Bronx, New York 10454

Effective: 08/03/2020 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 1080Service Type:

Program Name:

Certified Capacity:PRU 52790

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11871_Montef.pdf

Certificate Number: 190211872

1510 Waters Place, Bronx, New York 10461

Effective: 01/01/2018 2/28/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Medically Supervised Outpatient Withdrawal & Stabilization (816.8)

Outpatient Withdrawal

15Service Type:

Program Name:

Certified Capacity:PRU 52788

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11872_Montef.pdf

Certificate Number: 231111873

1510 Waters Place, Bronx, New York 10461

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822)

Wellness Center at Waters Place

995Service Type:

Program Name:

Certified Capacity:PRU 52786

with Telepractice Designation

Capacity Lifted

Opioid Medical Maintenance (822)

Wellness Center at Waters Place

Service Type:

Program Name:

Certified Capacity:PRU 52789

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11873_Montef.pdf

Certificate Number: 221211874

Track Level, 260 East 161st Street, Bronx, New York 10451

Effective: 08/05/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Wellness Center at Melrose

950Service Type:

Program Name:

Certified Capacity:PRU 52791

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11874_Montef.pdf

January 31, 2022 Page 123 of 227

Certificate Number: 240611875

1510 Waters Place, Bronx, New York 10461

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Next Steps North

Service Type:

Program Name:

Certified Capacity:PRU 52787

with Telepractice Designation

Outpatient Service (822)

Next Steps North

Service Type:

Program Name:

Certified Capacity:PRU 52915

with Telepractice Designation

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

S-Level, 260 East 161st Street, , Bronx, New York 10451

Effective: 08/05/2020 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Next Steps South

Service Type:

Program Name:

Certified Capacity:PRU 52792

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11876_Montef.pdf

Montefiore Nyack Hospital

Mark Geller M.D., President & CEO

160 North Midland Avenue, Nyack, NY 10960

Provider Number: 83100

Administrative Office:

Telephone - (845)-348-2110

Certificate Number: 190110257

Building B, 3rd Floor, 160 North Midland Avenue, Nyack, New York 10960

Effective: 02/05/2018 1/31/2019

Program Location:

Establishment Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6) 8Service Type:

Program Name:

Certified Capacity:PRU 51030

with Telepractice Designation [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10257_Montef.pdf

Certificate Number: 220111065

The Hub, 312 Route 59, , Central Nyack, New York 10960

Effective: 07/02/2021 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51650

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11065_Montef.pdf

Certificate Number: 190111415

Building B, 3rd Floor, 160 North Midland Avenue, Nyack, New York 10960

Effective: 02/05/2018 1/31/2019

Program Location:

Establishment Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

The Recovery Center

20Service Type:

Program Name:

Certified Capacity:PRU 51031

with Telepractice Designation

January 31, 2022 Page 124 of 227

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

Dr Jeremy Boal M.D., President

2 Dazian, First Ave. & 16th Street, New York, NY 10003

Provider Number: 83040

Administrative Office:

Telephone - (212)-420-2520

Certificate Number: 200712092

1st and 2nd Floors, 26 Avenue A, New York, New York 10009

Effective: 06/05/2020 7/31/2020

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

MMTP Avenue A Clinic

400Service Type:

Program Name:

Certified Capacity:PRU 53126

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12093_MountS.pdf

Certificate Number: 200712094

1st and 2nd Floors, 109-11 Delancey Street, New York, New York 10002

Effective: 06/05/2020 7/31/2020

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Gouverneur Clinic

450Service Type:

Program Name:

Certified Capacity:PRU 53125

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12094_MountS.pdf

Certificate Number: 210712096

2nd Floor, 25 12th Street, Brooklyn, New York 11215

Effective: 06/05/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Vincent P. Dole Clinic

600Service Type:

Program Name:

Certified Capacity:PRU 53131

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12096_MountS.pdf

Certificate Number: 200712097

Bernstein Pavilion, 6th Floor, 1-9 Nathan D. Perlman Place, New York, New York 10003

Effective: 08/01/2018 7/31/2020

Program Location:

Renewal Anticipated Recert Review:Deemed

Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 20Service Type:

Program Name:

Certified Capacity:PRU 53139

[with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12097_MountS.pdf

Certificate Number: 200712098

4th Floor, 103 East 125th Street, New York, New York 10035

Effective: 06/05/2020 7/31/2020

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Harlem No. 2

600Service Type:

Program Name:

Certified Capacity:PRU 53129

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12098_MountS.pdf

January 31, 2022 Page 125 of 227

Certificate Number: 210712099

2nd Floor, 103 East 125th Street, New York, New York 10035

Effective: 06/05/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Harlem No. 6/7

450Service Type:

Program Name:

Certified Capacity:PRU 53135

with Telepractice Designation

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

Bernstein Pavilion, 6th Floor, 1-9 Nathan D. Perlman Place, New York, New York 10003

Effective: 06/22/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53137

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53140

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12100_MountS.pdf

Certificate Number: 231212103

Bernstein Pavilion, 3rd Floor, 10 Nathan D. Perlman Place, New York, New York 10003

Effective: 02/18/2021 12/5/2023

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

Stuyvesant Square Chemical Dependency Treatment Program

30Service Type:

Program Name:

Certified Capacity:PRU 53136

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12103_MountS.pdf

Certificate Number: 210712104

6th Floor, 140 West 125th Street, New York, New York 10027

Effective: 06/05/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Clinic 8

800Service Type:

Program Name:

Certified Capacity:PRU 53130

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12104_MountS.pdf

Certificate Number: 210712105

8th Floor, 103 East 125th Street, New York, New York 10035

Effective: 06/05/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Clinic 1

800Service Type:

Program Name:

Certified Capacity:PRU 53128

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12105_MountS.pdf

January 31, 2022 Page 126 of 227

Certificate Number: 231212106

Bernstein Pavilion, 5th Floor, 1-9 Nathan D. Perlman Place, Pharmacy located on 16th Street and 1st Avenue, , New York, New York 10003

Effective: 02/18/2021 12/5/2023

Program Location:

Renewal Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6) 31Service Type:

Program Name:

Certified Capacity:PRU 53138

[with the use of methadone]

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

Mr Arthur Gianelli, CEO Mount Sinai St. Luke's Hospital

1111 Amsterdam Avenue, New York, NY 10025

Provider Number: 87090

Administrative Office:

Telephone - (212)-523-4000

Certificate Number: 240712107

Winston Building , 9th Floor, 1000 Tenth Avenue, , New York, New York 10019

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53143

with Telepractice Designation

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53144

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53148

with Telepractice Designation

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

306 West 102nd Street, New York, New York 10025

Effective: 09/01/2020 4/30/2022

Program Location:

Amendment Anticipated Recert Review:

Community Residential (819)

St. Luke's Roosevelt Hospital Halfway House

24Service Type:

Program Name:

Certified Capacity:PRU 53146

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12109_MountS.pdf

Certificate Number: 210712110

Winston Building, 8th Floor, 1000 Tenth Avenue, , New York, New York 10019

Effective: 09/01/2020 7/14/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6) 15Service Type:

Program Name:

Certified Capacity:PRU 53141

with Telepractice Designation [with the use of methadone] [up to 15 beds may be used for the provision of inpatient rehabilitation service as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12110_MountS.pdf

January 31, 2022 Page 127 of 227

Certificate Number: 210712111

Winston Building, 8th Floor, 1000 Tenth Avenue, , New York, New York 10019

Effective: 09/01/2020 7/14/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

Mt. Sinai West IP

15Service Type:

Program Name:

Certified Capacity:PRU 53145

with Telepractice Designation [up to 15 beds may be used for the provision of medically managed withdrawal & stabilization services (816.6) as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12111_MountS.pdf

Certificate Number: 210712112

429 West 58th Street, New York, New York 10019

Effective: 09/01/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 350Service Type:

Program Name:

Certified Capacity:PRU 53149

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12112_MountS.pdf

Certificate Number: 220812275

1111 Amsterdam Avenue, , New York, New York 10025

Effective: 09/13/2021 8/31/2022

Program Location:

Establishment Anticipated Recert Review:

Other Licensed PractitionersService Type:

Program Name:

Certified Capacity:PRU 53576

Psychosocial Rehabilitation (PSR)

CARES (Comprehensive Adolescent Rehabilitation and Education Services)

Service Type:

Program Name:

Certified Capacity:PRU 53577

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12275_MountS.pdf

Mountain View Prevention Services, Inc.

Mr. Christopher Paige, Executive Director

7714 Number Three Road, Lowville, NY 13367

Provider Number: 36320

Administrative Office:

Telephone - (315)-376-2321

Certificate Number: 230212035

Administrative Site Only:, First Floor East, 7714 Number Three Road, Lowville, New York 13367

Effective: 03/01/2021 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90693

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:

South Lewis Central School, 2nd Floor, Room 209, 4264 East Road, Turin, NY 13473

Other Service Site(s) At:

Copenhagen Central School, 1st Floor, Room 73A, 3020 Mechanic Street, Copenhagen, NY 13620

Other Service Site(s) At:

Harrisville Central School, Room A115, 14357 Pirate Lane, Harrisville, NY 13648

Other Service Site(s) At:

January 31, 2022 Page 128 of 227

Adirondack Central School, 8181 State Route 294, Boonville, NY 13309

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12035_Mounta.pdf

Mountainside NYC LLC

Ms. Alexandra Helfer LMHC, Executive Director

Suite 1601, 2nd Floor, 347 West 36th Street, New York, NY 10018

Provider Number: 50170

Administrative Office:

Telephone - (860)-824-1397 Ext 165

Certificate Number: 210512149

2nd Floor, 480 Bedford Road, Chappaqua, New York 10514

Effective: 05/28/2020 5/31/2021

Program Location:

Amendment Anticipated Recert Review:

d/b/a Mountainside Chappaqua

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53240

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12149_Mounta.pdf

Certificate Number: 231212195

2nd Floor, 141 East Main Street, , Huntington, New York 11743

Effective: 01/01/2021 12/31/2023

Program Location:

Renewal Anticipated Recert Review:

d/b/a Mountainside Huntington

Outpatient Service (822)

Mountainside Huntington Outpatient

Service Type:

Program Name:

Certified Capacity:PRU 53352

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12195_Mounta.pdf

Nassau Alternative Advocacy Program, Inc.

Mr. Timothy Andrews, Executive Director

Suite 102, 151 Herricks Road, Garden City Park, NY 11040

Provider Number: 41400

Administrative Office:

Telephone - (516)-741-3111

Certificate Number: 201211269

Suite 102, 151 Herricks Road, Garden City Park, New York 11040

Effective: 05/29/2020 12/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51819

with Telepractice Designation

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

Ms. Omayra Perez, Director

Suite 200, 60 Charles Lindbergh Boulevard, Uniondale, NY 11553

Provider Number: 40150

Administrative Office:

Telephone -

January 31, 2022 Page 129 of 227

Certificate Number: 210210368

Nassau County Medical Center, Building K, 2nd Floors, Basement, 1st &, 2201 Hempstead Turnpike, East Meadow, New York 11554

Effective: 07/10/2020 2/28/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 650Service Type:

Program Name:

Certified Capacity:PRU 52127

with Telepractice Designation

Opioid Medical Maintenance (822)Service Type:

Program Name:

Certified Capacity:PRU 52128

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10368_Nassau.pdf

Nassau Health Care Corporation d/b/a Nassau University Medical Hospital

Mr. Anthony Boutin, Chief Executive Officer

Building G, 2201 Hempstead Turnpike, East Meadow, NY 11554

Provider Number: 85020

Administrative Office:

Telephone - 516-572-8730

Certificate Number: 210610273

10th Floor, 2201 Hempstead Turnpike, East Meadow, New York 11554

Effective: 07/12/2018 6/9/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6) 20Service Type:

Program Name:

Certified Capacity:PRU 50296

[with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10273_Nassau.pdf

Certificate Number: 210611615

10th Floor, 2201 Hempstead Turnpike, East Meadow, New York 11554

Effective: 07/12/2018 6/9/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818) 30Service Type:

Program Name:

Certified Capacity:PRU 52094

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11615_Nassau.pdf

National Society for Hebrew Day Schools

Mr. Martin Wangrofsky, Executive Director

Suite 203, 813 Quentin Road, Brooklyn, NY 11223

Provider Number: 796

Administrative Office:

Telephone - (718)-787-4412

January 31, 2022 Page 130 of 227

Certificate Number: 210211977

Suite 203, 813 Quentin Road, Brooklyn, New York 11223

Effective: 12/07/2020 2/28/2021

Program Location:

Amendment Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90739

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90740

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90741

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90742

with Telepractice Designation

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90743

with Telepractice Designation

Bet Yaakov Orot Sarah, Room 303, 1125 Avenue N, Brooklyn, NY 11230

Other Service Site(s) At:

Bnos Yaakov of Pupa, 1st Floor, Guidance Office, 1402 40th Street, Brooklyn, NY 11218

Other Service Site(s) At:

Ezra Academy, 5th Floor, Conference Room, 119-45 Union Turnpike, Forest Hills, NY 11375

Other Service Site(s) At:

Hebrew Academy of Nassau County, 2nd Floor, Conference Room, 609 Hempstead Avenue, West Hempstead, NY 11552

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:

Beth Rivka Elementary School, 1st Floor, Conference Room, 470 Lefferts Avenue, Brooklyn, NY 11225

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:

Shulamith School for Girls, 2nd Floor, Guidance Office, 1277 East 14th Street, 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:

January 31, 2022 Page 131 of 227

The Pathways Study Center, Ground Floor, 1305 Coney Island Avenue, Brooklyn, NY 11230

Other Service Site(s) At:

Bnow Yisroel School for Girls, 1629 E. 15th Street, Brooklyn, NY 11229

Other Service Site(s) At:

Yeshiva Ktana of Manhattan, 1st Floor, Guidance Office, 348 West 89th Street, New York, NY 10024

Other Service Site(s) At:

Yeshiva Ahavas Torah, 2961 Nostrand Avenue, Brooklyn, NY 11229

Other Service Site(s) At:

Tomer Devora School for Girls, Tutoring Room B, 4500 9th Avenue, Brooklyn, NY 11220

Other Service Site(s) At:

Yeshiva Toras Emes Kamenitz, 4th Floor, Library, 1904 Avenue N, Brooklyn, NY 11230

Other Service Site(s) At:

Bais Chaya Mushka, 1505 Carroll Street, Brooklyn, NY 11213

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:

Beth Jacob of Boro Park, Basement, 1372 46th Street, Brooklyn, NY 11219

Other Service Site(s) At:

Yeshiva of Brooklyn, 1st Floor, Guidance Office, 1470 Ocean Parkway, 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:

Bais Yaakov Academy, 1213 Elm Avenue, Brooklyn, NY 11230

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 & Mesivta Torah Temimah, Room 401, 555 Ocean Parkway, Brooklyn, NY 11218

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 Darchei Torah, 257 Beach 17th Street, Far Rockaway, NY 11691

Other Service Site(s) At:

Mirrer Yeshiva High School, 1st Floor, Guidance Office, 1795 Ocean Parkway, Brooklyn, NY 11223

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:

Torah Academy for Girls, Room 308, 444 Beach 6th Street, Far Rockaway, NY 11691

Other Service Site(s) At:

January 31, 2022 Page 132 of 227

Yeshiva and Mesivta Torah Vodaath, 4th Floor, Guidance Office, 425 East 9th Street, Brooklyn, NY 11218

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:

Mesivtha Tifereth Jerusalem, 1st Floor, Guidance Room, 145 East Broadway, New York, NY 10002

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.

Ms. Ann Shalof, Executive Director

Suite 1301, 50 Broadway, New York, NY 10004

Provider Number: 19920

Administrative Office:

Telephone - (212)-537-5120

Certificate Number: 220811623

Basement, 921-923 Madison Avenue, New York, New York 10021

Effective: 08/31/2020 8/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Chance for Change

Service Type:

Program Name:

Certified Capacity:PRU 52103

with Telepractice Designation

Outpatient Service (822)

Chance for Change

Service Type:

Program Name:

Certified Capacity:PRU 52103

with Telepractice Designation

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.

Mr. Patricia Mauer, President and Chief Executive Officer

20 Crofts Road, Hurley, NY 12443

Provider Number: 19010

Administrative Office:

Telephone - (845)-339-4272 Ext 12

Certificate Number: 220211630

20 Crofts Road, Hurley, New York 12443

Effective: 03/01/2020 2/28/2022

Program Location:

Renewal Anticipated Recert Review:

Residential Rehabilitation Services for Youth (817) 22Service Type:

Program Name:

Certified Capacity:PRU 51240

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11630_NeverA.pdf

New Hope Manor, Inc.

Ms. Sarah Eilbacher, Executive Director

35 Hillside Road, Barryville, NY 12719

Provider Number: 219

Administrative Office:

Telephone - (845)-557-8353

Certificate Number: 231212047

35 Hillside Road, Barryville, New York 12719

Effective: 01/01/2021 12/31/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 53Service Type:

Program Name:

Certified Capacity:PRU 53065

and up to 12 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered

January 31, 2022 Page 133 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12047_NewHop.pdf

Certificate Number: 220112068

1st & 2nd Floors, 141 South Avenue, Poughkeepsie, New York 12601

Effective: 02/01/2021 1/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Residential Services (820) 10Service Type:

Program Name:

Certified Capacity:PRU 53064

and up to 3 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12068_NewHop.pdf

The New Horizon Counseling Center, Inc.

Mr. Herrick Lipton, Chief Executive Officer

108-19 Rockaway Boulevard, South Ozone, NY 11420

Provider Number: 15440

Administrative Office:

Telephone - (718)-845-2670

Certificate Number: 240411865

50 West Hawthorne Avenue, Valley Stream, New York 11580

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52804

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11865_NewHor.pdf

The New York and Presbyterian Hospital

Steven J. Corwin M.D., Chief Executive Officer

525 East 68th Street, New York, NY 10065

Provider Number: 81170

Administrative Office:

Telephone - (212)-305-8000

Certificate Number: 230710400

The Helmsley Medical Tower, 1st Floor, 503 East 70th Street, New York, New York 10021

Effective: 07/08/2020 7/7/2023

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822) 200Service Type:

Program Name:

Certified Capacity:PRU 331

with Telepractice Designation

Opioid Medical Maintenance (822)Service Type:

Program Name:

Certified Capacity:PRU 52205

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10400_NewYor.pdf

Certificate Number: 200511414

8 North Unit, 7-8-8A, 2nd Floor, 21 Bloomingdale Road, White Plains, New York 10605

Effective: 01/01/2018 5/20/2020

Program Location:

Special ReIssue Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818) 14Service Type:

Program Name:

Certified Capacity:PRU 50289

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11414_NewYor.pdf

New York Center For Living, Inc.

Audrey Freshman Ph.D., Executive Director

226 East 52nd Street, New York, NY 10022

Provider Number: 45160

Administrative Office:

Telephone - 212-712-8800

January 31, 2022 Page 134 of 227

Certificate Number: 220712029

224-226 East 52nd Street, New York, New York 10022

Effective: 05/29/2020 7/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53007

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12029_NewYor.pdf

New York City Department of Police

Tremaine Sayles, Executive Director

Medical Division NYPD, 15th Floor, 59-17 Junction Blvd, Corona, NY 11368

Provider Number: 28880

Administrative Office:

Telephone - 718-760-7557

Certificate Number: 190411596

25 Elm Place, , Brooklyn, New York 11201

Effective: 05/01/2018 4/30/2019

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52068

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

Mr. William Hicks, Chief Executive Officer

H Building, NB-ME8, 462 First Avenue, New York, NY 10016

Provider Number: 85120

Administrative Office:

Telephone - (212)-562-4132

Certificate Number: 230210442

4th Floor, 462 First Avenue, New York, New York 10016

Effective: 05/01/2021 2/26/2023

Program Location:

Renewal Anticipated Recert Review:Deemed

Opioid Treatment Program (822) 400Service Type:

Program Name:

Certified Capacity:PRU 422

[with ancillary withdrawal services for up to 40 patients] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10442_NewYor.pdf

Certificate Number: 231210618

C & D Building, 2nd Floor, 462 First Avenue, New York, New York 10016

Effective: 03/10/2021 12/31/2023

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51912

[with ancillary withdrawal services] with Telepractice Designation

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

Ms. Svetlana Lipyanskaya, Chief Executive Officer

Room 2W6, 2601 Ocean Parkway, Brooklyn, NY 11235

Provider Number: 87050

Administrative Office:

Telephone - (718)-616-6020

January 31, 2022 Page 135 of 227

Certificate Number: 240410558

2925 West 19th Street, Brooklyn, New York 11224

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50320

with Telepractice Designation [with ancillary withdrawal services]

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

Michelle Lewis, Chief Executive Officer

100 North Portland Avenue, Brooklyn, NY 11205

Provider Number: 85450

Administrative Office:

Telephone - 718-260-7895

Certificate Number: 220610578

1st & 2nd Floors, Basement,, 100 North Portland Avenue, Brooklyn, New York 11205

Effective: 07/01/2021 6/30/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)

Alcoholism Treatment Program

Service Type:

Program Name:

Certified Capacity:PRU 51910

with Telepractice Designation [with ancillary withdrawal services]

Outpatient Rehabilitation Service (822)

Alcoholism Treatment Program

Service Type:

Program Name:

Certified Capacity:PRU 53165

with Telepractice Designation

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

New York City Health and Hospitals Corporation Elmhurst Hospital Center

Mr. Israel Rocha, Chief Executive Officer

Annex O, 8th Floor, 79-01 Broadway, Elmhurst, NY 11373

Provider Number: 87040

Administrative Office:

Telephone - (718)-334-1638

Certificate Number: 220910464

Annex O, 2nd Floor, 79-01 Broadway, , Elmhurst, New York 11373

Effective: 04/14/2021 9/28/2022

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822) 300Service Type:

Program Name:

Certified Capacity:PRU 320

with Telepractice Designation [with ancillary withdrawal services for up to 30 patients]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10464_NewYor.pdf

Certificate Number: 220910900

Building H, 3rd Floor, 79-01 Broadway, Elmhurst, New York 11373

Effective: 04/14/2021 9/28/2022

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)

Elmhurst Hospital

Service Type:

Program Name:

Certified Capacity:PRU 50223

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10900_NewYor.pdf

January 31, 2022 Page 136 of 227

New York City Health and Hospitals Corporation Harlem Hospital Center

Ms. Eboné Carrington, Chief Executive Officer

Room MLK 2143, 506 Lenox Avenue, New York, NY 10037

Provider Number: 85130

Administrative Office:

Telephone - (212)-939-1340

Certificate Number: 230510610

Mural Pavilion, 5th Floor, 506 Lenox Avenue, , New York, New York 10037

Effective: 06/01/2021 5/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50316

with Telepractice Designation [with ancillary withdrawal services]

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

Mr. Christopher Mastromano, CEO

Building 1, Room 159, 1400 Pelham Parkway South, Bronx, NY 10461

Provider Number: 85140

Administrative Office:

Telephone - (718)-918-8141

Certificate Number: 220610609

Jacobi Medical Center, Floor #s 9W & 9N, Building #1, 1400 Pelham Parkway South, Bronx, New York 10461

Effective: 07/01/2021 6/30/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51889

with Telepractice Designation [with ancillary withdrawal services]

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

Mr. Sheldon McLeod, Chief Executive Officer

B Building, Suite B1137, 451 Clarkson Avenue, Brooklyn, NY 11203

Provider Number: 87030

Administrative Office:

Telephone - (718)-245-3901

Certificate Number: 240310462

Support Office Building (SOB), 591 Kingston Avenue, , Brooklyn, New York 11203

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:Deemed

Opioid Treatment Program (822) 750Service Type:

Program Name:

Certified Capacity:PRU 920

with Telepractice Designation [with ancillary withdrawal services for up to 75 patients]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10462_NewYor.pdf

Certificate Number: 220910574

R Building, 2 South Wing, 2nd Floor, 410 Winthrop Street, Brooklyn, New York 11203

Effective: 08/31/2020 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51909

with Telepractice Designation [with ancillary withdrawal services]

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53163

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10574_NewYor.pdf

January 31, 2022 Page 137 of 227

New York City Health and Hospitals Corporation Lincoln Medical and Mental Health Center

Mr. Milton Nunez, Executive Director

234 East 149th Street, Bronx, NY 10451

Provider Number: 84150

Administrative Office:

Telephone - (718)-579-5700

Certificate Number: 220710894

545 East 142nd Street, Bronx, New York 10454

Effective: 07/31/2020 7/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Recovery Center at Belvis Diagnostic & Treatment Center

Service Type:

Program Name:

Certified Capacity:PRU 6813

with Telepractice Designation

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

Ms. Alina Moran, Executive Director

Suite 1B2, 1901 First Avenue, New York, NY 10029

Provider Number: 81210

Administrative Office:

Telephone - (212)-423-7727

Certificate Number: 221010402

Psychiatric Pavillion, Room 2M29, 2nd Floor, 1900 2nd Avenue, , New York, New York 10029

Effective: 08/03/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 300Service Type:

Program Name:

Certified Capacity:PRU 669

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10402_NewYor.pdf

New York City Health and Hospitals Corporation Queens Hospital Center

Mr. Israel Rocha, CEO

Pavilion Building, Room 345, 82-50 164th Street, Jamaica, NY 11432

Provider Number: 87060

Administrative Office:

Telephone - (718)-883-2351

Certificate Number: 210510621

Pavilion Building, Room 345, 3rd Floor, 82-50 164th Street, , Jamaica, New York 11432

Effective: 08/21/2020 5/31/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)

Comprehensive Chemical Dependency Program

Service Type:

Program Name:

Certified Capacity:PRU 51908

with Telepractice Designation

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

Mr Gregory J. Calliste, Chief Executive Officer

Administrative Office, 760 Broadway, Brooklyn, NY 11206

Provider Number: 85180

Administrative Office:

Telephone - (718)-519-3500

Certificate Number: 230310898

5th& 9th Floors, 760 Broadway, Brooklyn, New York 11206

Effective: 09/17/2020 3/7/2023

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50911

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10898_NewYor.pdf

January 31, 2022 Page 138 of 227

New York State Office of Addiction Services and Supports Bronx Addiction Treatment Center

Ms Tabatha Cotto,

Building #13, Room 205, 2nd Floor, 1500 Waters Place, Bronx, NY 10461

Provider Number: 90008

Administrative Office:

Telephone -

Certificate Number: 220311378

Building 13, 1500 Waters Place, , Bronx, New York 10461

Effective: 10/29/2019 3/31/2022

Program Location:

Special ReIssue Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Bronx ATC IP

38Service Type:

Program Name:

Certified Capacity:PRU 50740

with Telepractice Designation [with the use of methadone]

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

Ms. Elaine DuBissette, Director

Pilgrim Psychiatric Center Campus - Building 1, 998 Crooked Hill Road, West Brentwood, NY 11717

Provider Number: 90013

Administrative Office:

Telephone - (631)-434-7554

Certificate Number: 240911379

Pilgrim Psychiatric Center, Building 1, North Wing, 1st and 2nd Floors, 998 Crooked Hill Road, West Brentwood, New York 11717

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 51Service Type:

Program Name:

Certified Capacity:PRU 50749

with Telepractice Designation [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11379_NewYor.pdf

Certificate Number: 181211432

Pilgrim Psychiatric Center, First Floor, North Wing, Building 1, 998 Crooked Hill Road, West Brentwood, New York 11717

Effective: 07/24/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 42Service Type:

Program Name:

Certified Capacity:PRU 50753

with Telepractice Designation

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

Ms. Margaret Hurst, Director

Building 19, CBU 15, 80-45 Winchester Boulevard, Queens Village, NY 11427

Provider Number: 90009

Administrative Office:

Telephone - (718)-264-3755

Certificate Number: 240312127

Building 19, CBU 15, 80-45 Winchester Boulevard, Queens Village, New York 11427

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 26Service Type:

Program Name:

Certified Capacity:PRU 53203

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12127_NewYor.pdf

January 31, 2022 Page 139 of 227

New York State Office of Addiction Services and Supports Dick Van Dyke Addiction Treatment Center

Mr. Andrew Merrill, Director

Room 229, 1330 County Road 132, Ovid, NY 14521

Provider Number: 90003

Administrative Office:

Telephone - (315)-835-6153

Certificate Number: 240811381

[Mailing Address at], Ovid, New York 14521, 1330 County Road 132, 7116 County Road 132, Bldg. 112, [Services Provided at], Willard, New York 14588

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 30Service Type:

Program Name:

Certified Capacity:PRU 50725

with Telepractice Designation [with the use of methadone]

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

Mr. Jason Goldwasser, Director

Building 1, Room 146, 1stFloor, 1111 Elmwood Avenue, Rochester, NY 14620

Provider Number: 90002

Administrative Office:

Telephone - (716)-461-0410 Ext 240

Certificate Number: 240211382

Rochester Psychiatric Center, Building 1, 1st Floor, 1732 South Avenue, Rochester, New York 14620

Effective: 03/01/2021 2/29/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 44Service Type:

Program Name:

Certified Capacity:PRU 50722

with Telepractice Designation [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11382_NewYor.pdf

New York State Office of Addiction Services and Supports Kingsboro Addiction Treatment Center

Ms. Vibeke Velez, Director

Main Building, Room 206, 2nd Floor, 754 Lexington Avenue, Brooklyn, NY 11221

Provider Number: 90014

Administrative Office:

Telephone - (718)-453-3200

Certificate Number: 240811383

754 Lexington Avenue, , Brooklyn, New York 11221

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 10Service Type:

Program Name:

Certified Capacity:PRU 51996

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]

Inpatient Rehabilitation Service ( 818) 60Service Type:

Program Name:

Certified Capacity:PRU 53442

with Telepractice Designation

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

Mr. Robert Chapman, Executive Director

360 Forest Avenue, Buffalo, NY 14213

Provider Number: 90001

Administrative Office:

Telephone - (716)-882-4900 Ext 225

January 31, 2022 Page 140 of 227

Certificate Number: 240611385

Building 37, 360 Forest Avenue, Buffalo, New York 14213

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 33Service Type:

Program Name:

Certified Capacity:PRU 50719

with Telepractice Designation [with the use of methadone]

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

Mr. Stephen McLaughlin, Director

Room B203, 2nd Floor, 1213 Court Street, Utica, NY 13502

Provider Number: 90004

Administrative Office:

Telephone - (315)-738-4600

Certificate Number: 220211386

1213 Court Street, Utica, New York 13502

Effective: 03/01/2020 2/28/2022

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 68Service Type:

Program Name:

Certified Capacity:PRU 50727

with Telepractice Designation [with the use of methadone]

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

Ms. Antonette Whyte-Etere, BATC Director

Administration Wing, Building 92 - Suite 12-16, 1st Floor, 117 Seward Avenue, Middletown, NY 10940

Provider Number: 90006

Administrative Office:

Telephone - (631)-403-3650

Certificate Number: 240912157

Building 92, Suites 12-16, 117 Seward Avenue, , Middletown, New York 10940

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 48Service Type:

Program Name:

Certified Capacity:PRU 53495

with Telepractice Designation [with the use of methadone]

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

Ms. Emily Feiner, Director

Building 57, 140 Old Orangeburg Road, Orangeburg, NY 10962

Provider Number: 90007

Administrative Office:

Telephone - (845)-680-7638 Ext 7638

Certificate Number: 241011387

Rockland Psychiatric Center, Building 57, 5th and 6th Floors, 140 Old Orangeburg Road, , Orangeburg, New York 10962

Effective: 11/01/2021 10/31/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 52Service Type:

Program Name:

Certified Capacity:PRU 50735

with Telepractice Designation [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11387_NewYor.pdf

January 31, 2022 Page 141 of 227

New York State Office of Addiction Services and Supports South Beach Addiction Treatment Center

Ms. Nadia Huntley-Smith, Director

South Beach Psychiatric Center, Building 3, Room 807, 2nd Floor, 777 Seaview Avenue, Staten Island, NY 10305

Provider Number: 90012

Administrative Office:

Telephone - (718)-667-5202

Certificate Number: 241111388

South Beach Psychiatric Center, Building 3, 777 Seaview Avenue, Staten Island, New York 10305

Effective: 12/01/2021 11/30/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 30Service Type:

Program Name:

Certified Capacity:PRU 50748

with Telepractice Designation [with the use of methadone]

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

Mr. William Coppola, Director

Hamilton Hall, 1 Chimney Point Drive, Ogdensburg, NY 13669

Provider Number: 90005

Administrative Office:

Telephone - (315)-393-1180

Certificate Number: 240311389

1 Chimney Point Drive, Ogdensburg, New York 13669

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 40Service Type:

Program Name:

Certified Capacity:PRU 50730

with Telepractice Designation [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11389_NewYor.pdf

New York State Office of Children and Family Services

Ms. Sheila J. Poole, Acting Commissioner

Office of Program Services/Division of Rehabilitation Services, Capital View Office Park, 6th Floor, 52 Washington Street, Rensselaer, NY 12144

Provider Number: 28720

Administrative Office:

Telephone - (845)-615-3011

Certificate Number: 180611788

Brookwood Secure Center, 419 Spookrock Road, P.O. Box 265, Claverack, New York 12513

Effective: 01/01/2018 6/30/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Chemical Dependency Specialized Services (824)

Discrete Addiction Service Unit

30Service Type:

Program Name:

Certified Capacity:PRU 52649

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11788_NewYor.pdf

Certificate Number: 180611791

Highland Residential Center, Unit #41, 629 North Chodikee Lake Road, PO Box 970, Highland, New York 12528

Effective: 01/01/2018 6/30/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Chemical Dependency Specialized Services (824)

Discrete Addiction Service Unit

17Service Type:

Program Name:

Certified Capacity:PRU 52651

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11791_NewYor.pdf

January 31, 2022 Page 142 of 227

New York Therapeutic Communities, Inc.

Mr Sandeep Varma, Chief Executive Officer/President

21st Floor, 266 West 37th Street, New York, NY 10018

Provider Number: 587

Administrative Office:

Telephone - (212)-971-6033

Certificate Number: 231110210

2071 Fulton Street, Brooklyn, New York 11233

Effective: 12/01/2021 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Serendipity I - The John David Center

57Service Type:

Program Name:

Certified Capacity:PRU 5682

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10210_NewYor.pdf

Certificate Number: 181211306

Floors 1-4, 944 Bedford Avenue, , Brooklyn, New York 11205

Effective: 01/17/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Serendipity II - The Madeline Randers Center

40Service Type:

Program Name:

Certified Capacity:PRU 7191

for women

Intensive Residential Rehabilitation (819)

Serendipity II - The Madeline Randers Center

40Service Type:

Program Name:

Certified Capacity:PRU 7191

for women

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11306_NewYor.pdf

Certificate Number: 210911486

2071 Fulton Street, Brooklyn, New York 11233

Effective: 04/25/2019 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 51994

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11486_NewYor.pdf

Certificate Number: 221111583

Lower Level, 162-24 Jamaica Avenue, Jamaica, New York 11432

Effective: 10/02/2020 11/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52057

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11583_NewYor.pdf

Niagara County Department of Mental Health Services

Ms. Laura Kelemen, Director

Suite #200, 5467 Upper Mountain Road, Lockport, NY 14094

Provider Number: 70150

Administrative Office:

Telephone - (716)-439-7410

January 31, 2022 Page 143 of 227

Certificate Number: 220512026

Trott Access Center, 2nd Floor, 1001 11th Street, Niagara Falls, New York 14301

Effective: 09/04/2020 5/31/2022

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52984

with Telepractice Designation

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.

Ms. Jennifer Barron, Director of Services

25 Dies Street, Canton, NY 13617

Provider Number: 36160

Administrative Office:

Telephone - (315)-379-0139 Ext 4

Certificate Number: 181210151

25 Dies Street, Canton, New York 13617

Effective: 01/01/2018 12/31/2018

Program Location:

Conditional Certificate Anticipated Recert Review:

Community Residential (819)

Canton House Community Residential Service

24Service Type:

Program Name:

Certified Capacity:PRU 50499

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10151_NorthC.pdf

North Crown Heights Family Outreach Center, Inc.

Ms. Susana Dobrer, Executive Director

765 Nostrand Avenue #763, Brooklyn, NY 11216

Provider Number: 42930

Administrative Office:

Telephone - (718)-230-8600

Certificate Number: 230511459

763-765 Nostrand Avenue, Brooklyn, New York 11216

Effective: 06/01/2021 5/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51973

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11459_NorthC.pdf

North Shore Child and Family Guidance Association, Inc.

Mr. Andrew Malekoff, Executive Director/CEO

480 Old Westbury Road, Roslyn Heights, NY 11577

Provider Number: 21730

Administrative Office:

Telephone - (516)-626-1971 Ext 302

Certificate Number: 211211497

999 Brush Hollow Road, Westbury, New York 11590

Effective: 06/22/2020 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51657

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11497_NorthS.pdf

January 31, 2022 Page 144 of 227

Northpointe Council, Inc.

Ms. Kristi Yerger, President & CEO

Suite 2A, 800 Main Street, Niagara Falls, NY 14301

Provider Number: 38020

Administrative Office:

Telephone - (716)-282-1228

Certificate Number: 190710509

2470 Allen Avenue, Niagara Falls, New York 14303

Effective: 01/01/2018 7/31/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Medically Monitored Withdrawal & Stabilization Services (816.9)

First Step Center

17Service Type:

Program Name:

Certified Capacity:PRU 8028

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10509_Northp.pdf

Certificate Number: 220910656

Lockview Plaza, Suite 201, Second Floor, 41 Main Street, Lockport, New York 14094

Effective: 04/09/2020 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50083

with Telepractice Designation

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: 240611250

1001 11th Street, Niagara Falls, New York 14301

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51852

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11250_Northp.pdf

Certificate Number: 221011696

1001 11th Street, , Niagara Falls, New York 14301

Effective: 04/09/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Full Agonist Treatment Program (822) 85Service Type:

Program Name:

Certified Capacity:PRU 52232

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11696_Northp.pdf

Certificate Number: 210712075

2470 Allen Avenue, Niagara Falls, New York 14303

Effective: 08/01/2018 7/31/2021

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

First Step Center

7Service Type:

Program Name:

Certified Capacity:PRU 52971

- [up to 7 beds may be used for the provision of medically monitored withdrawal & stabilization services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12075_Northp.pdf

January 31, 2022 Page 145 of 227

Northwell Healthcare, Inc. as Sponsor Phelps Memorial Hospital Association as Operator

Ms. Eileen Egan, Executive Director

Administration - 1st Floor, 701 North Broadway, Sleepy Hollow, NY 10591

Provider Number: 85310

Administrative Office:

Telephone -

Certificate Number: 220910597

22 Rockledge Avenue, Ossining, New York 10562

Effective: 04/22/2020 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51620

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51941

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10597_Northw.pdf

Certificate Number: 220911392

2nd Floor (South Wing), 701 North Broadway, , Sleepy Hollow, New York 10591

Effective: 10/02/2020 9/28/2022

Program Location:

Amendment Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

Behavioral Rehabilitation Unit

22Service Type:

Program Name:

Certified Capacity:PRU 51617

with Telepractice Designation

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

Mr Michael Scarpelli, Executive Director

400 Sunrise Highway, Amityville, NY 11701

Provider Number: 81980

Administrative Office:

Telephone - (631)-608-5105

Certificate Number: 210110634

Carone Hall, Basement and First Floor, 400 Sunrise Highway, , Amityville, New York 11701

Effective: 06/22/2020 1/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Outpatient Substance Use Disorder Clinic

Service Type:

Program Name:

Certified Capacity:PRU 50697

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10634_Northw.pdf

Certificate Number: 210111424

Jennings Hall, 1st Floor, 400 Sunrise Highway, Amityville, New York 11701

Effective: 02/19/2020 1/31/2021

Program Location:

Establishment Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 28Service Type:

Program Name:

Certified Capacity:PRU 50696

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11424_Northw.pdf

January 31, 2022 Page 146 of 227

Certificate Number: 210111489

Jennings Hall, 2nd Floor, 400 Sunrise Highway, Amityville, New York 11701

Effective: 02/19/2020 1/31/2021

Program Location:

Establishment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 24Service Type:

Program Name:

Certified Capacity:PRU 50695

[with the use of methadone]

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

Mr. Kenneth Roberts, President

75 North Country Road, Port Jefferson, NY 11777

Provider Number: 83220

Administrative Office:

Telephone - (631)-473-1320 Ext 4215

Certificate Number: 240810840

1st Floor, 100 Highlands Boulevard, , Port Jefferson, New York 11777

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Mather Outpatient Chemical Dependence Program

Service Type:

Program Name:

Certified Capacity:PRU 50023

with Telepractice Designation

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

Carolyn Sweetapple Ph.D., Executive Director

ACP Suite 2309, 75-59 263rd Street, Glen Oaks, NY 11004

Provider Number: 85210

Administrative Office:

Telephone - (718)-470-4887

Certificate Number: 221010450

(Clinic) 75-59 263rd Street, 1st Floor, Glen Oaks, NY 11004-1150 , (Billing), 270-05 76th Avenue, , New Hyde Park, New York 11040

Effective: 05/28/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 375Service Type:

Program Name:

Certified Capacity:PRU 307

with Telepractice Designation [with ancillary withdrawal services for up to 38 patients]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10450_Northw.pdf

Certificate Number: 211010557

1st Floor Suite 160 and 2, 600 Hempstead Turnpike, , West Hempstead, New York 11552

Effective: 05/28/2020 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Project Outreach

Service Type:

Program Name:

Certified Capacity:PRU 431

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10557_Northw.pdf

Certificate Number: 221010639

2nd Floor, 1600 Central Avenue, Far Rockaway, New York 11691

Effective: 05/28/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50021

with Telepractice Designation

January 31, 2022 Page 147 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10639_Northw.pdf

Certificate Number: 221010855

(Clinic) 75-59 263rd Street, Basement, Glen Oaks, New York 11004-1150, (Billing), 270-05 76th Avenue, , New Hyde Park, New York 11040

Effective: 05/28/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 3089

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10855_Northw.pdf

Certificate Number: 221010858

711 Stewart Avenue, , Garden City, New York 11530

Effective: 05/28/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Garden City Treatment Center

Service Type:

Program Name:

Certified Capacity:PRU 50064

with Telepractice Designation

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

Brahim Ardolic M.D., Executive Director

475 Seaview Avenue, Staten Island, NY 10305

Provider Number: 85200

Administrative Office:

Telephone - (718)-226-9761

Certificate Number: 221210446

111 Water Street, Staten Island, New York 10304

Effective: 03/10/2021 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 220Service Type:

Program Name:

Certified Capacity:PRU 944

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10446_Northw.pdf

Certificate Number: 211010447

Methadone Annex, 1st & 2nd Floors, 392 Seguine Avenue, , Staten Island, New York 10309

Effective: 03/10/2021 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 550Service Type:

Program Name:

Certified Capacity:PRU 304

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10447_Northw.pdf

Certificate Number: 211010449

1st Floor, 567 East 105th Street, , Brooklyn, New York 11236

Effective: 03/10/2021 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 400Service Type:

Program Name:

Certified Capacity:PRU 7150

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10449_Northw.pdf

January 31, 2022 Page 148 of 227

Certificate Number: 221011027

Original Building, North & South Wings, 2nd Floor, 392 Seguine Avenue, Staten Island, New York 10309

Effective: 03/10/2021 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51422

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11027_Northw.pdf

Certificate Number: 221011406

Main Hospital Building, 3rd Floor, North Wing, 375 Seguine Avenue, , Staten Island, New York 10309

Effective: 12/09/2021 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Staten Island University Hospital Prince's Bay

24Service Type:

Program Name:

Certified Capacity:PRU 51623

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

Mr. Tzvi Heber, CEO

113 East 60th Street, New York, NY 10022

Provider Number: 49900

Administrative Office:

Telephone - (917)-262-0003

Certificate Number: 221212126

Floors 1-6, 113 East 60th Street, New York, New York 10022

Effective: 11/30/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 15Service Type:

Program Name:

Certified Capacity:PRU 53204

with Telepractice Designation [up to 6 of these beds may be used for the provision of inpatient rehabilitation services, as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12126_OceanR.pdf

Certificate Number: 201212220

Basement, Rooms 005, 006, 007, 010, 1st Floor, Rooms 102, 107, 113 East 60th Street, , New York, New York 10022

Effective: 10/02/2020 12/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53264

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12220_OceanR.pdf

Certificate Number: 241012243

5th & 6th Floors, 113 East 60th Street, , New York, New York 10022

Effective: 11/01/2021 10/31/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Ascendant NY

3Service Type:

Program Name:

Certified Capacity:PRU 53520

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12243_OceanR.pdf

January 31, 2022 Page 149 of 227

Oceanside Counseling Center, Inc.

Ms Teresa Maguire, Director

71 Homecrest Court, Oceanside, NY 11572

Provider Number: 11500

Administrative Office:

Telephone - (516)-766-6283 Ext 14

Certificate Number: 210810910

School Building 6, 2nd Floor, 71 Homecrest Court, , Oceanside, New York 11572

Effective: 06/22/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6438

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10910_Oceans.pdf

Odyssey House, Inc.

Peter Provet Ph.D., President and Chief Executive Officer

17th Floor, 120 Wall Street, New York, NY 10005

Provider Number: 19400

Administrative Office:

Telephone - (212)-361-1617

Certificate Number: 181210052

219-233 East 121st Street, New York, New York 10035

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Odyssey Manor

196Service Type:

Program Name:

Certified Capacity:PRU 6817

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10052_Odysse.pdf

Certificate Number: 181210053

Basement, 1st-4th Floors, 309-311 East 6th Street, New York, New York 10003

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 60Service Type:

Program Name:

Certified Capacity:PRU 957

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10053_Odysse.pdf

Certificate Number: 181210055

George Rosenfeld Center for Recovery, 13 Hell Gate Circle, Ward's Island, New York 10035

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Odyssey Ward's Island

97Service Type:

Program Name:

Certified Capacity:PRU 52848

Intensive Residential Rehabilitation (819)

Odyssey Ward's Island

74Service Type:

Program Name:

Certified Capacity:PRU 53066

and up to 60 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10055_Odysse.pdf

Certificate Number: 210611460

Suite 301, 3rd Floor, 953 Southern Boulevard, Bronx, New York 10459

Effective: 08/25/2020 6/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7392

with Telepractice Designation

January 31, 2022 Page 150 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11460_Odysse.pdf

Certificate Number: 190411582

1264 Lafayette Avenue, Bronx, New York 10474

Effective: 01/01/2018 4/30/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 16Service Type:

Program Name:

Certified Capacity:PRU 52056

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11582_Odysse.pdf

Certificate Number: 200811793

1328 Clinton Avenue, 1322, 1326 &, Bronx, New York 10456

Effective: 01/01/2018 8/31/2020

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 57Service Type:

Program Name:

Certified Capacity:PRU 52659

and up to 14 beds for children

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

Ms LaRay Brown, President/CEO

1545 Atlantic Avenue, Brooklyn, NY 11213

Provider Number: 85470

Administrative Office:

Telephone - (718)-613-4001

Certificate Number: 240410300

6 East, 1545 Atlantic Avenue, Brooklyn, New York 11213

Effective: 10/27/2021 4/23/2024

Program Location:

Renewal Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6) 20Service Type:

Program Name:

Certified Capacity:PRU 50586

with Telepractice Designation [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10300_OneBro.pdf

Certificate Number: 240510457

880 Bergen Street, , Brooklyn, New York 11238

Effective: 10/29/2021 5/7/2024

Program Location:

Correction Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Interfaith Medical Center MMTP Clinic

450Service Type:

Program Name:

Certified Capacity:PRU 335

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10457_OneBro.pdf

Certificate Number: 221010834

Bishop O.G. Walker, Jr. Health Center, 528 Prospect Place, , Brooklyn, New York 11238

Effective: 10/27/2021 10/4/2022

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50587

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53012

with Telepractice Designation

January 31, 2022 Page 151 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10834_OneBro.pdf

Certificate Number: 221011371

6 West, 1545 Atlantic Avenue, Brooklyn, New York 11213

Effective: 10/27/2021 10/4/2022

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818) 20Service Type:

Program Name:

Certified Capacity:PRU 7038

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11371_OneBro.pdf

Onondaga-Cortland-Madison BOCES

Mr. Phil Grome, Assistant Superintendent for Administration

110 Elwood Davis Road, Syracuse, NY 13121

Provider Number: 36380

Administrative Office:

Telephone - (315)-433-2614

Certificate Number: 220612014

Administrative Site Only:, 110 Elwood Davis Road, , Syracuse, New York 13121

Effective: 07/01/2019 6/30/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90696

Immaculate Conception School, 400 Salt Springs Road, Fayetteville, NY 13066

Other Service Site(s) At:

Blessed Sacrament School, 3129 James Street, Syracuse, NY 13206

Other Service Site(s) At:

St. Mary's Academy, 49 Syracuse Street, Baldwinsville, NY 13027

Other Service Site(s) At:

Our Lady of Pompei School, 923 North McBride Street, Syracuse, NY 13208

Other Service Site(s) At:

St. Margaret's School, 200 Roxboro Road, Mattydale, NY 13211

Other Service Site(s) At:

Bishop Grimes JHS, 6653 Kirkville Road, East Syracuse, NY 13057

Other Service Site(s) At:

Bishop Ludden, 815 Fay Road, Syracuse, NY 13219

Other Service Site(s) At:

St. Rose of Lima School, 411 South Main Street, North Syracuse, NY 13212

Other Service Site(s) At:

Most Holy Rosary School, 1031 Bellevue Avenue, Syracuse, NY 13207

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12014_Ononda.pdf

Open Arms, Incorporated

Ms. Barbara Swift, Executive Director

57-59 Sharp Street, Haverstraw, NY 10927

Provider Number: 34360

Administrative Office:

Telephone - (845)-271-3787

January 31, 2022 Page 152 of 227

Certificate Number: 181210119

57-59 Sharp Street, Haverstraw, New York 10927

Effective: 01/01/2018 12/31/2018

Program Location:

Conditional Certificate Anticipated Recert Review:

Community Residential (819)

Open Arms Halfway House

18Service Type:

Program Name:

Certified Capacity:PRU 50943

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10119_OpenAr.pdf

Certificate Number: 181211472

57-59 Sharp Street, Haverstraw, New York 10927

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819) 20Service Type:

Program Name:

Certified Capacity:PRU 51524

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11472_OpenAr.pdf

Certificate Number: 181211771

74 Hudson Avenue, , Haverstraw, New York 10927

Effective: 01/01/2018 12/31/2018

Program Location:

Conditional Certificate Anticipated Recert Review:

Community Residential (819) 12Service Type:

Program Name:

Certified Capacity:PRU 52613

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11771_OpenAr.pdf

Osborne Treatment Services, Inc.

Ms. Elizabeth Gaynes, President/CEO

809 Westchester Avenue, Bronx, NY 10455

Provider Number: 1879

Administrative Office:

Telephone - (718)-707-2600

Certificate Number: 240511272

Basement, 1st-3rd Floors, 809 Westchester Avenue, Bronx, New York 10455

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7323

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11272_Osborn.pdf

Oswego County Opportunities, Inc.

Ms. Diane Cooper-Currier, Executive Director

239 Oneida Street, Fulton, NY 13069

Provider Number: 40660

Administrative Office:

Telephone - (315)-598-4717 Ext 1017

Certificate Number: 190810186

239 Oneida Street, RECORDS ONLY are located at:, Fulton, New York 13069-1228, 53 Hall Road, R.D. #1, Hannibal, New York 13074

Effective: 01/01/2018 8/31/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819)

Arbor House Supportive Living Program

10Service Type:

Program Name:

Certified Capacity:PRU 51425

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10186_Oswego.pdf

January 31, 2022 Page 153 of 227

Certificate Number: 181210187

53 Hall Road, Hannibal, New York 13074

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Arbor House

16Service Type:

Program Name:

Certified Capacity:PRU 50966

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10187_Oswego.pdf

Otsego County Community Services Board

Jeannette Pavlus, Director

3rd Floor, 242 Main Street, Oneonta, NY 13820

Provider Number: 70120

Administrative Office:

Telephone - (607)-433-2343

Certificate Number: 221210917

Otsego County Satellite Office Building, 2nd Floor, 242 Main Street, Oneonta, New York 13820

Effective: 07/10/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Otsego County Community Services Chemical Dependencies Clinic

Service Type:

Program Name:

Certified Capacity:PRU 50325

with Telepractice Designation

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

Ms. Kathryn Connerton, Chief Executive Officer

169 Riverside Drive, Binghamton, NY 13905

Provider Number: 82150

Administrative Office:

Telephone - (607)-798-5334

Certificate Number: 210211968

Administrative Site Only:, 184 Court Street, Binghamton, New York 13901

Effective: 03/01/2019 2/28/2021

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90733

Chenango Valley High School, 2nd Floor, Guidance Office, 221 Chenango Bridge Road, Binghamton, NY 13901

Other Service Site(s) At:

Johnson City Middle School, Room 114D, 601 Columbia Drive, Johnson City, NY 13790

Other Service Site(s) At:

Leslie F. Distin Education Center BOCES, 435 Glenwood Road, Binghamton, NY 13905

Other Service Site(s) At:

Deposit High School, 1st Floor, Guidance Office, 171 2nd Street, Deposit, NY 13754

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:

Chenango Forks High School, 1st Floor, Room 100-1, 1 Gordon Drive, Binghamton, NY 13901

Other Service Site(s) At:

Binghamton High School, 3rd Floor, Room A307, 31 Main Street, Binghamton, NY 13905

Other Service Site(s) At:

January 31, 2022 Page 154 of 227

Maine-Endwell Middle School, 1st Floor, Room #142, 1119 Farm To Market Road, Endwell, NY 13760

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:

Whitney Point High School, 1st Floor, Guidance Suite, 10 Keibel Road, Whitney Point, NY 13862

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:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11968_OurLad.pdf

Outreach Development Corporation

Ms. Debra Pantin, President/CEO

Richmond Hill Building, 2nd Floor, 117-11 Myrtle Avenue, Richmond Hill, NY 11418

Provider Number: 31360

Administrative Office:

Telephone - (718)-847-9233 Ext 2232

Certificate Number: 211110561

Unit C and D, 1st Floor, 11 Farber Drive, , Bellport, New York 11713

Effective: 04/22/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Outreach Project - Bellport

Service Type:

Program Name:

Certified Capacity:PRU 6594

with Telepractice Designation

Outpatient Rehabilitation Service (822)

Outreach Project - Bellport

Service Type:

Program Name:

Certified Capacity:PRU 6635

with Telepractice Designation

Longwood High School, 100 Longwood Road, Middle Island, NY 11953

Additional Location(s) At:

OTI Building, 1st Floor, Office #2 and Conference Room #2, 400 Crooked Hill Road, Brentwood, NY 11717

Additional Location(s) At:

Mercy First -Syosset Campus, 525 Convent Road, Syosset, NY 11791

Additional Location(s) At:

Eastern Suffolk BOCES-Bellport Academic Center, 350 Martha Avenue, Bellport, NY 11713

Additional Location(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10561_Outrea.pdf

Certificate Number: 240810563

Basement, 1st and 2nd Floors, 117-11 Myrtle Avenue, Richmond Hill, New York 11418

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

The Outreach Project

Service Type:

Program Name:

Certified Capacity:PRU 7210

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10563_Outrea.pdf

January 31, 2022 Page 155 of 227

Certificate Number: 221211273

2nd & 3rd Floors, 960 Manhattan Avenue, Brooklyn, New York 11222

Effective: 04/22/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51847

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11273_Outrea.pdf

Certificate Number: 211011790

452 Suffolk Avenue, Brentwood, New York 11717

Effective: 04/22/2020 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52648

with Telepractice Designation

Pilgrim Psychiatric Center, Buckman Clinic - Building #47, 998 Crooked Hill Road, Brentwood, NY 11717

Additional Location(s) At:

Pilgrim Psychiatric Center-Building #56, Western Suffolk Clinic - Building #56, 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

and Basement, 1st-3rd Floors, 16-14 Weirfield Street, Ridgewood, New York 11385

Effective: 03/01/2021 2/29/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Rehabilitation Services for Youth (817) 30Service Type:

Program Name:

Certified Capacity:PRU 53003

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12031_Outrea.pdf

Certificate Number: 240912032

400 Crooked Hill Road, Brentwood, New York 11717

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Rehabilitation Services for Youth (817) 45Service Type:

Program Name:

Certified Capacity:PRU 53002

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10093_Outrea.pdf

Certificate Number: 210612076

Pilgrim Psychiatric Center, Building #5, 1st and 2nd Floors, 998 Crooked Hill Road, , Brentwood, New York 11717

Effective: 01/25/2021 6/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53093

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12076_Outrea.pdf

January 31, 2022 Page 156 of 227

Certificate Number: 201212219

27A Washington Place, , Roosevelt, New York 11575

Effective: 04/22/2020 12/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Outreach's REACT Center

Service Type:

Program Name:

Certified Capacity:PRU 53483

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12219_Outrea.pdf

Certificate Number: 240812221

Building #4, 400 Crooked Hill Road, , Brentwood, New York 11717

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Outreach's Recovery Residence for Women

25Service Type:

Program Name:

Certified Capacity:PRU 53263

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12221_Outrea.pdf

Certificate Number: 220412264

Pilgrim Psychiatric Center, Building #5, 1st and 2nd Floors, 998 Crooked Hill Road, , Brentwood, New York 11717

Effective: 05/07/2021 4/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820) 36Service Type:

Program Name:

Certified Capacity:PRU 53558

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12264_Outrea.pdf

The PAC Program of the Bronx, Inc.

Ms. Maria Mendez, Executive Vice President/COO

1215-1217 Stratford , Bronx, NY 10472

Provider Number: 47080

Administrative Office:

Telephone - (718)-328-2605

Certificate Number: 221211691

1215-1217 Stratford Avenue, Bronx, New York 10472

Effective: 06/05/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52233

with Telepractice Designation

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52233

with Telepractice Designation

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.

David Ockert Ph.D., Executive Director

6th Floor, 145 East 32nd Street, New York, NY 10016

Provider Number: 1898

Administrative Office:

Telephone - (212)-779-9207

January 31, 2022 Page 157 of 227

Certificate Number: 240910500

6th Floor, 145 East 32nd Street, New York, New York 10016

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 25Service Type:

Program Name:

Certified Capacity:PRU 8020

[without the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10500_Parall.pdf

Certificate Number: 220710920

6th Floor, 145 East 32nd Street, New York, New York 10016

Effective: 09/01/2020 7/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 5513

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10920_Parall.pdf

Pearl Street Counseling Center, Inc.

Mr. Guy Kuperman, Executive Director

1st Floor, 109 State Street, Albany, NY 12207

Provider Number: 651

Administrative Office:

Telephone - (518)-462-4320

Certificate Number: 210611525

1st Floor, 109 State Street, Albany, New York 12207

Effective: 07/01/2019 6/30/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 1694

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11525_PearlS.pdf

Phoenix Houses of Long Island, Inc.

Ms. Ann Marie M. Foster, President and CEO

34-11 Vernon Boulevard, Long Island City, NY 11106

Provider Number: 50570

Administrative Office:

Telephone - (718)-222-6673

Certificate Number: 181211308

220 Veterans Memorial Highway, Hauppauge, New York 11788

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Phoenix House Hauppauge Center

65Service Type:

Program Name:

Certified Capacity:PRU 2013

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11308_Phoeni.pdf

Certificate Number: 181211310

95 Industrial Road, Wainscott, New York 11975

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Phoenix House Academy of Long Island

45Service Type:

Program Name:

Certified Capacity:PRU 6298

with Telepractice Designatioin

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11310_Phoeni.pdf

January 31, 2022 Page 158 of 227

Certificate Number: 231011778

287 Springs-Fireplace Road, East Hampton, New York 11937

Effective: 11/01/2020 10/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

East Hampton Outpatient Services

Service Type:

Program Name:

Certified Capacity:PRU 52627

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11778_Phoeni.pdf

Certificate Number: 230412080

Basement, 1st-5th Floors, 34-25 Vernon Boulevard, Long Island City, New York 11106

Effective: 05/01/2021 4/30/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 190Service Type:

Program Name:

Certified Capacity:PRU 53073

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12080_Phoeni.pdf

Certificate Number: 200212155

153, 153A, and 161 Lake Shore Road, , Lake Ronkonkoma, New York 11779

Effective: 03/04/2019 2/29/2020

Program Location:

Conversion Anticipated Recert Review:

Residential Services (820)

Phoenix House - Lake Ronkonkoma

96Service Type:

Program Name:

Certified Capacity:PRU 53273

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12155_Phoeni.pdf

Certificate Number: 220112184

1st Floor, 34-11 Vernon Boulevard, , Long Island City, New York 11106

Effective: 06/10/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Parkside Outpatient Program

Service Type:

Program Name:

Certified Capacity:PRU 53318

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12184_Phoeni.pdf

Postgraduate Center for Mental Health

Mr. Jacob Barak, CEO

158 East 35th Street, New York, NY 10016

Provider Number: 18270

Administrative Office:

Telephone - (212)-899-5500 Ext 205

Certificate Number: 220512190

8th Floor, 1775 Grand Concourse, , Bronx, New York 10453

Effective: 06/01/2021 5/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:OASAS Host

Outpatient Service (822)

Bronx Recovery Support Center

Service Type:

Program Name:

Certified Capacity:PRU 53437

with Telepractice Designation

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

January 31, 2022 Page 159 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12190_Postgr.pdf

PRCD, Inc.

Ms Mandy Teeter, Vice President, Rochester Regional Health-Behavioral Health

3rd Floor, 81 Lake Avenue, Rochester, NY 14608

Provider Number: 37360

Administrative Office:

Telephone - (585)-922-5497

Certificate Number: 181210266

2650 Ridgeway Avenue, Rochester, New York 14626

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Barbara Wolk Schwarz Women Residence

24Service Type:

Program Name:

Certified Capacity:PRU 51037

for women and with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10266_PRCDIn.pdf

The Prevention Council of Erie County, Inc.

Ms. Robin Mann, Executive Director

1625 Hertel Avenue, Buffalo, NY 14216

Provider Number: 38040

Administrative Office:

Telephone - (716)-831-2298

Certificate Number: 211112001

1st Floor, 1625 Hertel Avenue, Buffalo, New York 14216

Effective: 02/03/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Prevention Counseling

Student Assistance Prevention Counseling Program

Service Type:

Program Name:

Certified Capacity:PRU 90711

School #66 - North Park Middle Academy, Guidance Office, 780 Parkside Avenue, Buffalo, NY 14216

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:

Enterprise Charter School, 1st Floor, Social Worker's Office, 275 Oak Street, Buffalo, NY 14203

Other Service Site(s) At:

Riverside Institute of Technology, Room 131, 51 Ontario Street, Buffalo, NY 14215

Other Service Site(s) At:

McKinley High School, Room 210, 1500 Elmwood Avenue, Buffalo, NY 14207

Other Service Site(s) At:

East High School, 820 Northampton Avenue, Buffalo, NY 14211

Other Service Site(s) At:

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:

School #18, Room 316, 118 Hampshire Street, Buffalo, NY 14213

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12001_ErieCo.pdf

Professional Counseling Services, Inc.

Ms. Darlene Angelicchio, President

Medical Center West, Suite #118, 1st Floor, 5700 West Genesee Street, Camillus, NY 13031

Provider Number: 49850

Administrative Office:

Telephone - (315)-488-1641

January 31, 2022 Page 160 of 227

Certificate Number: 220112121

Medical Center West, Suite #118, 1st Floor, 5700 West Genesee Street, , Camillus, New York 13031

Effective: 05/04/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53177

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12121_Profes.pdf

Project Hospitality, Inc.

Ms. Jaclyn Stoll, Interim Executive Director

100 Park Avenue, Staten Island, NY 10302

Provider Number: 19900

Administrative Office:

Telephone - (718)-448-1544 Ext 110

Certificate Number: 230610948

14 Slosson Terrace, Staten Island, New York 10301

Effective: 07/01/2021 6/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51157

with Telepractice Designation

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

Certificate Number: 240812148

Bayley Seton Campus, 1st Floor - F Wing, 75 Vanderbilt Avenue, Staten Island, New York 10304

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

PREP

20Service Type:

Program Name:

Certified Capacity:PRU 53232

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12148_Projec.pdf

Project Renewal, Inc.

Mr. Eric Rosenbaum, President & Chief Executive Officer

9th Floor, 200 Varick Street, New York, NY 10014

Provider Number: 50470

Administrative Office:

Telephone - (212)-620-0340

Certificate Number: 231110196

4th Floor, Eight East Third Street, New York, New York 10003

Effective: 12/01/2021 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Medically Monitored Withdrawal & Stabilization Services (816.9) 30Service Type:

Program Name:

Certified Capacity:PRU 51112

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10196_Projec.pdf

January 31, 2022 Page 161 of 227

Certificate Number: 210910949

1st Floor, 8 East Third Street, New York, New York 10003

Effective: 06/05/2020 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Project Renewal Chemical Dependence Outpatient Clinic

Service Type:

Program Name:

Certified Capacity:PRU 50052

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10949_Projec.pdf

Certificate Number: 210211600

2nd & 3rd Floors, 8 East Third Street, , New York, New York 10003

Effective: 10/21/2020 2/17/2021

Program Location:

Emergency Anticipated Recert Review:

Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 30Service Type:

Program Name:

Certified Capacity:PRU 52081

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11600_Projec.pdf

Certificate Number: 210112224

2nd Floor, 179 East 116th Street, , New York, New York 10029

Effective: 11/19/2020 1/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Project Renewal Support and Connection Center

Service Type:

Program Name:

Certified Capacity:PRU 53475

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Putnam Family and Community Services, Inc. d/b/a CoveCare Center

Mr. Eric Toth, Chief Executive Officer

1808 Route Six, Carmel, NY 10512

Provider Number: 27700

Administrative Office:

Telephone - (845)-225-2700 Ext 246

Certificate Number: 211210952

1808 Route Six, Carmel, New York 10512

Effective: 09/04/2020 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Chemical Dependency Treatment Services

Service Type:

Program Name:

Certified Capacity:PRU 50422

with Telepractice Designation

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

Ms. Jordania Estrella, Chief Operating Officer

40-11 Warren Street, Elmhurst, NY 11373

Provider Number: 44510

Administrative Office:

Telephone - (212)-837-2013

Certificate Number: 240511491

40-11 Warren Street, Elmhurst, New York 11373

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

The PAC Program

Service Type:

Program Name:

Certified Capacity:PRU 51997

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11491_QSASer.pdf

January 31, 2022 Page 162 of 227

The REACH Project, Inc.

Justine Waldman M.D., CEO

1001 W. Seneca Street, Ithaca, NY 14850

Provider Number: 51440

Administrative Office:

Telephone - (607)-273-7000

Certificate Number: 210712234

1st Floor, 1001 W. Seneca Street, , Ithaca, New York 14850

Effective: 03/05/2021 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53498

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12234_TheREA.pdf

Reality House, Inc.

Mr. Hewitt DePass, Executive Director

8-13 Astoria Boulevard, Astoria, NY 11102

Provider Number: 19660

Administrative Office:

Telephone - (212)-281-6004 Ext 302

Certificate Number: 220711685

8-13 Astoria Boulevard, Astoria, New York 11102

Effective: 05/29/2020 7/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52219

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11685_Realit.pdf

Certificate Number: 181211799

8-13 Astoria Boulevard, Astoria, New York 11102

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Reality House Veterans Community Residence

30Service Type:

Program Name:

Certified Capacity:PRU 52642

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11799_Realit.pdf

Realization Center, Inc.

Ms. Marilyn J. White, Executive Director and Chief Executive Officer

7th Floor, 19 Union Square West, New York, NY 10003

Provider Number: 27270

Administrative Office:

Telephone - (212)-627-9600

Certificate Number: 220210955

7th Floor, 19 Union Square West, New York, New York 10003

Effective: 11/19/2020 2/28/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Realization Center Clinic

Service Type:

Program Name:

Certified Capacity:PRU 7073

[with ancillary withdrawal services] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10955_Realiz.pdf

January 31, 2022 Page 163 of 227

Certificate Number: 221011350

2nd Floor, 175 Remsen Street, Brooklyn, New York 11201

Effective: 11/01/2020 10/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7393

[with ancillary withdrawal services] with Telepractice Designation

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

Ms. Kim Brumber, President and Chief Executive Officer

Suite 200, 259 Monroe Avenue, Rochester, NY 14607

Provider Number: 50410

Administrative Office:

Telephone - (585)-238-4823

Certificate Number: 200210191

259 Monroe Avenue, Rochester, New York 14607

Effective: 01/03/2020 2/29/2020

Program Location:

Amendment Anticipated Recert Review:

Supportive Living (819)

Crossroads Apartment Program

72Service Type:

Program Name:

Certified Capacity:PRU 51260

with Telepractice Designation

and up to 12 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10191_Recove.pdf

Certificate Number: 200210192

109 Dartmouth Street, Rochester, New York 14607

Effective: 03/21/2019 2/29/2020

Program Location:

Establishment Anticipated Recert Review:

Community Residential (819)

Hirst House

12Service Type:

Program Name:

Certified Capacity:PRU 50038

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10192_Recove.pdf

Certificate Number: 200210193

561 Mount Hope Avenue, Rochester, New York 14620

Effective: 03/21/2019 2/29/2020

Program Location:

Establishment Anticipated Recert Review:

Community Residential (819)

Crossroads I, Hanson House

14Service Type:

Program Name:

Certified Capacity:PRU 50037

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10193_Recove.pdf

Certificate Number: 200210194

1st and 2nd Floors, Basement, 407 Frederick Douglass Street, Rochester, New York 14608

Effective: 03/21/2019 2/29/2020

Program Location:

Establishment Anticipated Recert Review:

Community Residential (819)

Crossroads III, Cody House

16Service Type:

Program Name:

Certified Capacity:PRU 50039

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10194_Recove.pdf

January 31, 2022 Page 164 of 227

Certificate Number: 200210195

50 Browncroft Boulevard, Rochester, New York 14609

Effective: 03/21/2019 2/29/2020

Program Location:

Establishment Anticipated Recert Review:

Community Residential (819)

Browncroft House

12Service Type:

Program Name:

Certified Capacity:PRU 51314

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10195_Recove.pdf

Regional Economic Community Action Program, Inc.

Mr. Charles Quinn, Chief Executive Officer

40 Smith Street, Middletown, NY 10940

Provider Number: 34070

Administrative Office:

Telephone - (845)-421-6243

Certificate Number: 190810116

Basement,, 1st & 2nd Floors, 127 Hickory Hill Road, Newburgh, New York 12550

Effective: 01/01/2018 8/31/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

RECAP - New Life Halfway House

24Service Type:

Program Name:

Certified Capacity:PRU 50196

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10116_Region.pdf

Certificate Number: 240611223

1st Floor, 40-48 Smith Street, Middletown, New York 10940

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50990

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11223_Region.pdf

Rego Park Counseling LLC

Mr Emanuil Kalendarev, Owner

1st Floor, 6336 99th Street, Rego Park, NY 11374

Provider Number: 51310

Administrative Office:

Telephone - (718)-496-3834

Certificate Number: 210112223

1st Floor, 6336 99th Street, , Rego Park, New York 11374

Effective: 08/21/2020 1/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 53489

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12223_RegoPa.pdf

Rehabilitation Support Services, Inc.

Mr. William DeVita, Executive Director

5172 Western Turnpike, Altamont, NY 12009

Provider Number: 14370

Administrative Office:

Telephone - (518)-464-1511

January 31, 2022 Page 165 of 227

Certificate Number: 181211313

Basement, 1st, 2nd & 3rd Floors, 11 Overbaugh Street, Saugerties, New York 12477

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Abel House

18Service Type:

Program Name:

Certified Capacity:PRU 51242

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11313_Rehabi.pdf

Renaissance Addiction Services, Inc.

Ms. Robin A. Clouden, Executive Director

920 Harlem Road, West Seneca, NY 14224

Provider Number: 48530

Administrative Office:

Telephone - (716)-827-9462

Certificate Number: 240911830

920 Harlem Road, West Seneca, New York 14224

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Rehabilitation Services for Youth (817)

Renaissance Addiction Services, Inc. (RASI)

47Service Type:

Program Name:

Certified Capacity:PRU 52733

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11830_Renais.pdf

Certificate Number: 220112164

920 Harlem Road, , West Seneca, New York 14224

Effective: 02/01/2021 1/31/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Promise House

15Service Type:

Program Name:

Certified Capacity:PRU 53536

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12164_Renais.pdf

Certificate Number: 220112179

920 Harlem Road, , West Seneca, New York 14224

Effective: 02/01/2021 1/31/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Palmerton Place

15Service Type:

Program Name:

Certified Capacity:PRU 53537

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Rensselaer County Department of Mental Health

Ms. Katherine Alonge-Coons, Commissioner

County Office Building, 3rd Floor, 1600 7th Avenue, Troy, NY 12180

Provider Number: 70300

Administrative Office:

Telephone - (518)-270-2807

Certificate Number: 230312013

Ned Pattison Rensselaer County Government Center, 3rd Floor, 1600 7th Avenue, Troy, New York 12180

Effective: 04/01/2020 3/31/2023

Program Location:

Renewal Anticipated Recert Review:

Prevention Counseling

Unified Services

Service Type:

Program Name:

Certified Capacity:PRU 90821

Algonquin Middle School, 1st Floor, Room 402, 333 NY Highway 351, Averill Park, NY 12018

Other Service Site(s) At:

Troy High School, 1950 Burdett Avenue, Troy, NY 12180

Other Service Site(s) At:

January 31, 2022 Page 166 of 227

Averill Park High School, 146 Gettle Road, Averill Park, NY 12018

Other Service Site(s) At:

Knickerbacker Middle/High School (Lansingburgh), 320 Seventh Avenue, Troy, NY 12182

Other Service Site(s) At:

Berlin Middle/High School, 17400 Route 22, Cherry Plain, NY 12040

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:

Goff Middle School, Office, 35 Gilligan Road, East Greenbush, NY 12061

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12013_Rensse.pdf

Renwick Recovery, Inc.

Mr. Dominic P. Fata, Chief Executive Officer

131 Mill Street, Newburgh, NY 12550

Provider Number: 15510

Administrative Office:

Telephone - (845)-569-0775

Certificate Number: 181210335

131 Mill Street, Newburgh, New York 12550

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819) 40Service Type:

Program Name:

Certified Capacity:PRU 51584

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10335_Renwic.pdf

The Rescue Mission of Utica, N.Y.

Mr. James Haid, Chief Executive Officer

293 Genesee Street, Utica, NY 13501

Provider Number: 36280

Administrative Office:

Telephone - (315)-735-1645 Ext 101

Certificate Number: 221212078

210 Lansing Street, Utica, New York 13501

Effective: 01/01/2020 12/31/2022

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 25Service Type:

Program Name:

Certified Capacity:PRU 53101

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12078_TheRes.pdf

Resource Recovery Center of Orange County, LLC

Mr. Michael Bentson, Chief Executive Officer

68 Crystal Run Road, Middletown, NY 10941

Provider Number: 50790

Administrative Office:

Telephone - (845)-209-3512 Ext 7011

Certificate Number: 231012181

1st & 2nd Floors, 68 Crystal Run Road, , Middletown, New York 10941

Effective: 01/19/2021 10/31/2023

Program Location:

Amendment Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 50Service Type:

Program Name:

Certified Capacity:PRU 53323

January 31, 2022 Page 167 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12181_Resour.pdf

Certificate Number: 231012182

1st Floor, 68 Crystal Run Road, , Middletown, New York 10941

Effective: 01/19/2021 10/31/2023

Program Location:

Amendment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 24Service Type:

Program Name:

Certified Capacity:PRU 53351

[up to 22 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12182_Resour.pdf

The Resource Training Center Inc.

Ms. AnnMarie Perrotto, President/CEO

3rd Floor, 4521 Arthur Kill Road, Staten Island, NY 10309

Provider Number: 46430

Administrative Office:

Telephone - (718)-605-1989 Ext 32

Certificate Number: 211011728

408 77th Street, , Brooklyn, New York 11209

Effective: 10/27/2021 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

d/b/a The Resource Counseling Center

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52554

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11728_Resour.pdf

Certificate Number: 220412144

3rd Floor, 4521 Arthur Kill Road, Staten Island, New York 10309

Effective: 05/01/2019 4/30/2022

Program Location:

Renewal Anticipated Recert Review:

d/b/a Christopher's Reason

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 53241

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12144_Resour.pdf

Restorative Management Corp.

Mr. Jeffrey Spitz LCSW, Executive Director

7 Railroad Avenue, Middletown, NY 10940

Provider Number: 1617

Administrative Office:

Telephone - (845)-561-5783

Certificate Number: 230110960

Floor 2, 7 Railroad Avenue, Middletown, New York 10940

Effective: 02/20/2020 1/31/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 6377

with Telepractice and Problem Gambling Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10960_Restor.pdf

January 31, 2022 Page 168 of 227

Certificate Number: 230210961

172-178 Liberty Street, , Newburgh, New York 12550

Effective: 03/01/2020 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 7265

with Telepractice and Program Gambling Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10961_Restor.pdf

Certificate Number: 221211702

Suite #108, 123 Pike Street, , Port Jervis, New York 12771

Effective: 02/20/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52245

with Telepractice and Problem Gambling Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11702_Restor.pdf

RevCore Recovery Center of Manhattan, LLC

Mr. Avraham Schick, Executive Director/CEO

181 Canal Street, New York, NY 10013

Provider Number: 49130

Administrative Office:

Telephone - (212)-966-9537

Certificate Number: 230211949

4th and 5th Floors, 181 Canal Street, New York, New York 10013

Effective: 03/01/2020 2/20/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52928

with Telepractice Designation

3rd Floor, 15 Second Avenue, Brooklyn, NY 11215

Additional Location(s) At:

Terence Cardinal Cooke Health Care Center (TCC), 4th Floor, Suite A-419, 1249 5th Avenue, New York, NY 10029

Additional Location(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11949_RevCor.pdf

Certificate Number: 230211950

3rd & 4th Floors, 37-20 74th Street, Jackson Heights, New York 11372

Effective: 03/01/2020 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52929

with Telepractice Designation

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

Mr. Daniel Messina, CEO

Active Parent Corporation: Bridge Regional Health System, Inc., 355 Bard Avenue, Staten Island, NY 10310

Provider Number: 45720

Administrative Office:

Telephone - (718)-818-2400

January 31, 2022 Page 169 of 227

Certificate Number: 240711634

Silberstein Center, 2nd Floor, 1130 South Avenue, , Staten Island, New York 10314

Effective: 7/31/2024

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Center for Young Adults

Service Type:

Program Name:

Certified Capacity:PRU 52125

with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]

Outpatient Service (822)

Center for Young Adults

Service Type:

Program Name:

Certified Capacity:PRU 53050

with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]

Outpatient Service (822)

Center for Young Adults

Service Type:

Program Name:

Certified Capacity:PRU 52125

with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]

Outpatient Service (822)

Center for Young Adults

Service Type:

Program Name:

Certified Capacity:PRU 53050

with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11634_Richmo.pdf

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11634_Richmo.pdf

Certificate Number: 230312139

1st and 2nd Floors, 444 St. Mark's Place, Staten Island, New York 10301

Effective: 04/01/2020 3/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53235

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12139_Richmo.pdf

RISE Housing and Support Services, Inc.

Ms Sybil Newell M.A, Executive Director

127 Union Street, Saratoga Springs, NY 12866

Provider Number: 50590

Administrative Office:

Telephone - (518)-587-6193

Certificate Number: 190611645

994 Route 67, , Ballston Spa, New York 12020

Effective: 01/01/2018 6/30/2019

Program Location:

Amendment Anticipated Recert Review:

Supportive Living (819)

Hedgerow House Apartment Program

6Service Type:

Program Name:

Certified Capacity:PRU 51069

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11645_Transi.pdf

Certificate Number: 200112180

994 Route 67, , Ballston Spa, New York 12020

Effective: 02/19/2019 1/31/2020

Program Location:

Amendment Anticipated Recert Review:

Residential Services (820)

Hedgerow House

16Service Type:

Program Name:

Certified Capacity:PRU 53320

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

January 31, 2022 Page 170 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12180_RISEHo.pdf

RiseBoro Community Partnership

Mr. Scott Short, Chief Executive Officer

555 Bushwick Avenue, Brooklyn, NY 11206

Provider Number: 23470

Administrative Office:

Telephone - (718)-821-0254

Certificate Number: 240411984

5th Floor, 1474 Gates Avenue, Brooklyn, New York 11237

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90769

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11984_RiseBo.pdf

The Riverdale Mental Health Association, Inc.

Donna Demetri-Friedman Ph.D., Executive Director

5676 Riverdale Avenue, Bronx, NY 10471

Provider Number: 18040

Administrative Office:

Telephone - (718)-796-5300 Ext 145

Certificate Number: 200911355

Rooms #201 & #202, 2nd Floor, 5676 Riverdale Avenue, Bronx, New York 10471

Effective: 09/04/2020 9/30/2020

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 2016

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11355_Riverd.pdf

Riverhead Community Awareness Program, Inc.

Ms. Felicia Scocozza, Executive Director

Suite 106, 518 East Main Street, Riverhead, NY 11901

Provider Number: 2011

Administrative Office:

Telephone - (631)-727-3722 Ext 102

Certificate Number: 240812222

Administrative Offices, Suite 106, 518 East Main Street, , Riverhead, New York 11901

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention Counseling

Riverhead CAP

Service Type:

Program Name:

Certified Capacity:PRU 90638

with Telepractice Designation

Roanoke Elementary School, 2nd Floor, Room 208, 549 Roanoke 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:

Riverhead High School, 2nd Floor, Room 205C, 700 Harrison Avenue, Riverhead, NY 11901

Other Service Site(s) At:

Phillips Avenue Elementary School, 1st Floor, Room 35, 141 Phillips 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

Ms. Jill Graziano, Vice President of Behavioral

1425 Portland Avenue, Rochester, NY 14621

Provider Number: 85320

Administrative Office:

Telephone - (585)-368-6931

January 31, 2022 Page 171 of 227

Certificate Number: 191111337

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

Effective: 01/01/2018 11/30/2019

Program Location:

Special ReIssue Anticipated Recert Review:Deemed

Outpatient Service (822)

Rochester Mental Health Center

Service Type:

Program Name:

Certified Capacity:PRU 50216

with Telepractice Designation

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

Mr. David B. Acker, President - CEO

50 Leroy Street, Potsdam, NY 13676

Provider Number: 83110

Administrative Office:

Telephone - (315)-261-6003

Certificate Number: 211210698

12 Elm Street, , Potsdam, New York 13676

Effective: 01/01/2021 12/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 51737

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10698_Roches.pdf

Certificate Number: 211211365

20 Cottage Street, , Potsdam, New York 13676

Effective: 01/01/2021 12/31/2021

Program Location:

Establishment Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

Chemical Dependency Services

17Service Type:

Program Name:

Certified Capacity:PRU 51183

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11365_Roches.pdf

Rochester Regional Health as Active Parent and Co-Operator of Gouverneur Hospital

Mr. Eric R. Burch, CEO

77 West Barney Street, Gouverneur, NY 13642

Provider Number: 50540

Administrative Office:

Telephone - 315-261-6006

Certificate Number: 211212186

1500 Wing 1st Fl. 2300 Wi, 77 West Barney Street, , Gouverneur, New York 13642

Effective: 06/04/2021 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 53281

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12186_Roches.pdf

Rockville Centre Drug and Alcohol Abuse - CONFIDE, Inc.

Ms Wanda Florentino, Executive Director

Suite H-6, 30 Hempstead Avenue, Rockville Centre, NY 11570

Provider Number: 78

Administrative Office:

Telephone - (516)-764-5522

January 31, 2022 Page 172 of 227

Certificate Number: 230311534

Suites H-6, H-9 & H-12, Basement, 30 Hempstead Avenue, Rockville Centre, New York 11570

Effective: 09/21/2020 3/31/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 498

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11534_Rockvi.pdf

Rome Memorial Hospital, Inc.

Mark Murphy M.D., President/Chief Executive Officer

1500 North James Street, Rome, NY 13440

Provider Number: 81810

Administrative Office:

Telephone - (315)-338-7021

Certificate Number: 221210962

Liberty Plaza, 264 West Dominick Street, Rome, New York 13440

Effective: 05/13/2020 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Community Recovery Center

Service Type:

Program Name:

Certified Capacity:PRU 51124

with Telepractice Designation

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

Ms. Ruth M. Meyer, Executive Director

Administrative Site, Suite E-14, 3281 Veterans Memorial Highway, Ronkonkoma, NY 11779

Provider Number: 12000

Administrative Office:

Telephone - (631)-471-3122

Certificate Number: 201211107

E14, 3281 Veterans Memorial Highway, Ronkonkoma, New York 11779

Effective: 09/04/2020 12/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51223

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11107_RuthMM.pdf

S.A.F.E. Foundation, Inc.

Mr. Ike Dweck, Chief Executive Officer

255 Avenue W, Brooklyn, NY 11223

Provider Number: 45700

Administrative Office:

Telephone - (866)-569-7233

Certificate Number: 230211635

255 Avenue W, Brooklyn, New York 11223

Effective: 08/25/2020 2/28/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

SAFE Foundation

Service Type:

Program Name:

Certified Capacity:PRU 52129

with Telepractice and Problem Gambling Designations

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

Mr. Joseph McKinsey, Chief Executive Officer

201 Fort Pond Boulevard, East Hampton, NY 11937

Provider Number: 47650

Administrative Office:

Telephone - (631)-604-5405

January 31, 2022 Page 173 of 227

Certificate Number: 241211743

15 Lohan Court, , Southampton, New York 11968

Effective: 01/01/2022 12/31/2024

Program Location:

Renewal Anticipated Recert Review:

Community Residential (819) 16Service Type:

Program Name:

Certified Capacity:PRU 52571

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11743_SafeHa.pdf

Certificate Number: 220911815

201 Fort Pond Boulevard, East Hampton, New York 11937

Effective: 10/28/2020 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

The Dunes

Service Type:

Program Name:

Certified Capacity:PRU 52720

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11815_SafeHa.pdf

Saint Regis Mohawk Tribe/ Saint Regis Mohawk Health Services

Mr. Michael Cook, Executive Director

Health and Human Services Division, 404 State Route 37, Akwesasne, NY 13655

Provider Number: 22290

Administrative Office:

Telephone - (518)-358-3141

Certificate Number: 201010963

404 State Route 37, , Akwasasne, New York 13655

Effective: 08/21/2020 10/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Alcohol/Chemical Dependency Program

Service Type:

Program Name:

Certified Capacity:PRU 5266

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10963_SaintR.pdf

Certificate Number: 210211393

Partridge House, 25 St. Regis Road, Hogansburg, New York 13655

Effective: 03/01/2018 2/28/2021

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 16Service Type:

Program Name:

Certified Capacity:PRU 50779

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11393_SaintR.pdf

The Salvation Army

Major John Haggerty, Chief Executive Director

Elmira Citadel, 414 Lake Street, Elmira, NY 14901

Provider Number: 37020

Administrative Office:

Telephone - (607)-732-0314

Certificate Number: 181210156

Basement, 1st & 2nd Flrs., 401-403 Division Street, Elmira, New York 14901

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Elmira Citadel

25Service Type:

Program Name:

Certified Capacity:PRU 50470

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10156_Salvat.pdf

January 31, 2022 Page 174 of 227

Samaritan Daytop Village, Inc.

Mr. Mitchell Netburn, President and Chief Executive Officer

Administrative Headquarters, 13802 Queens Boulevard, Jamaica, NY 11435

Provider Number: 16890

Administrative Office:

Telephone - (718)-206-2000 Ext 1200

Certificate Number: 181210038

1381 Dr. Martin Luther King Jr Blvd, Bronx, New York 10452

Effective: 01/01/2018 12/31/2018

Program Location:

Conditional Certificate Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 60Service Type:

Program Name:

Certified Capacity:PRU 3162

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10038_Samari.pdf

Certificate Number: 181210040

(Residence), 327 West 43rd Street, 8th Floor, (Counseling), 321 West 44th Street, New York, New York 10036

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 48Service Type:

Program Name:

Certified Capacity:PRU 6974

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10040_Samari.pdf

Certificate Number: 200510352

130-20 89th Road, , Richmond Hill, New York 11418

Effective: 04/29/2019 5/31/2020

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 150Service Type:

Program Name:

Certified Capacity:PRU 52532

[with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10352_Samari.pdf

Certificate Number: 210811278

144-10 Jamaica Avenue, , Jamaica, New York 11435

Effective: 08/23/2021 8/31/2021

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 6595

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53550

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11278_Samari.pdf

Certificate Number: 181211594

130-15 89th Road, Richmond Hill, New York 11418

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Richmond Hill Veterans Program

50Service Type:

Program Name:

Certified Capacity:PRU 52067

January 31, 2022 Page 175 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11594_Samari.pdf

Certificate Number: 181211750

Floors 1 - 3, 751 Briggs Highway, Ellenville, New York 12428

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819)

Women Veterans Program

25Service Type:

Program Name:

Certified Capacity:PRU 52579

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11750_Samari.pdf

Certificate Number: 181211827

Basement, 1st-4th Floors, 68 West 106th Street, New York, New York 10025

Effective: 01/01/2018 12/31/2018

Program Location:

Conditional Certificate Anticipated Recert Review:

Community Residential (819) 36Service Type:

Program Name:

Certified Capacity:PRU 52722

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11827_Samari.pdf

Certificate Number: 181211828

119 West 106th Street, New York, New York 10025

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 36Service Type:

Program Name:

Certified Capacity:PRU 52723

and up to 30 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11828_Samari.pdf

Certificate Number: 220311829

7th Floor, 2090 Adam Clayton Powell, Jr. Blvd., , New York, New York 10027

Effective: 08/05/2019 3/31/2022

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Outpatient Service (822)

Samaritan Daytop Village/Harlem Outpatient

0Service Type:

Program Name:

Certified Capacity:PRU 52724

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11829_Samari.pdf

Certificate Number: 220611915

1st Floor, 250 Grand Concourse, , Bronx, New York 10451

Effective: 04/16/2021 6/30/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 770Service Type:

Program Name:

Certified Capacity:PRU 52883

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11915_Samari.pdf

January 31, 2022 Page 176 of 227

Certificate Number: 220611916

1st & 2nd Floors, 362 East 148th Street, , Bronx, New York 10455

Effective: 11/15/2021 6/30/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Mott Haven OTP

850Service Type:

Program Name:

Certified Capacity:PRU 52882

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11916_Samari.pdf

Certificate Number: 210811937

5th Floor, 362 East 148th Street, , Bronx, New York 10455

Effective: 08/23/2021 8/31/2021

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52897

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11937_Samari.pdf

Certificate Number: 220211943

338 Forbell Street, , Brooklyn, New York 11208

Effective: 11/25/2019 2/28/2022

Program Location:

Conditional Certificate Anticipated Recert Review:OASAS Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52916

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MH 0Service Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11943_Samari.pdf

Certificate Number: 220411956

1st & 2nd Floors, 620 Route 303, Blauvelt, New York 10913

Effective: 05/01/2019 4/1/2022

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Outpatient Service (822)

Rockland Outreach Center

0Service Type:

Program Name:

Certified Capacity:PRU 52930

with Telepractice Designation [with ancillary withdrawal services]

Outpatient Rehabilitation Service (822)

Rockland Outreach Center

Service Type:

Program Name:

Certified Capacity:PRU 53103

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11956_Samari.pdf

January 31, 2022 Page 177 of 227

Certificate Number: 220311957

900 Arnow Avenue, Bronx, New York 10469

Effective: 04/01/2019 3/31/2022

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Outpatient Service (822)

Bronx Outreach Center

0Service Type:

Program Name:

Certified Capacity:PRU 52769

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11957_Samari.pdf

Certificate Number: 231111958

2075 New York Avenue, Huntington Station, New York 11746

Effective: 11/01/2020 10/31/2023

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Outpatient Service (822)

Suffolk Outreach Center

0Service Type:

Program Name:

Certified Capacity:PRU 52931

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11958_Samari.pdf

Certificate Number: 220211960

Basement & 1st Floor, 1915 Forest Avenue, Staten Island, New York 10303

Effective: 03/01/2019 2/28/2022

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Outpatient Service (822)

Staten Island Outreach Center

0Service Type:

Program Name:

Certified Capacity:PRU 52771

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11960_Samari.pdf

Certificate Number: 240212120

767 Cape Road, Ellenville, New York 12428

Effective: 03/01/2021 2/28/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 80Service Type:

Program Name:

Certified Capacity:PRU 53118

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12120_Samari.pdf

January 31, 2022 Page 178 of 227

Certificate Number: 231012226

751 Briggs Highway, , Ellenville, New York 12428

Effective: 11/01/2021 10/31/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 135Service Type:

Program Name:

Certified Capacity:PRU 53460

[Men's Dorm - 105 beds, Women's Dorm - 30 beds]

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12226_Samari.pdf

Certificate Number: 231012238

Buildings #4, 10, 11, 15 , 88 Fox Hollow Road, , Rhinebeck, New York 12572

Effective: 11/01/2021 10/31/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Meadow Run Female Program SRR

56Service Type:

Program Name:

Certified Capacity:PRU 53512

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12238_Samari.pdf

Certificate Number: 211012239

190 Fox Hollow Road, , Rhinebeck, New York 12572

Effective: 11/02/2020 10/31/2021

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820)

Fox Run Male Program

92Service Type:

Program Name:

Certified Capacity:PRU 53513

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Certificate Number: 220912286

88-83 Van Wyck Expressway, , Jamaica, New York 11435

Effective: 10/01/2021 9/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820) 96Service Type:

Program Name:

Certified Capacity:PRU 53586

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12286_Samari.pdf

Certificate Number: 220912287

130-20 89th Road, , Richmond Hill, New York 11418

Effective: 10/01/2021 9/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820) 104Service Type:

Program Name:

Certified Capacity:PRU 53515

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12287_Samari.pdf

Samaritan Medical Center

Mr. Thomas Carman, Chief Executive Officer

830 Washington Street, Watertown, NY 13601

Provider Number: 15920

Administrative Office:

Telephone - (315)-785-4000

January 31, 2022 Page 179 of 227

Certificate Number: 220310969

1st Floor, 1575 Washington Street, Watertown, New York 13601

Effective: 07/01/2020 3/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Samaritan Medical Center Addiction Services

Service Type:

Program Name:

Certified Capacity:PRU 51705

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10969_Samari.pdf

Saratoga County Community Services Board

Michael S. Prezioso Ph.D., CommissionerServices

135 South Broadway, Saratoga Springs, NY 12866

Provider Number: 70840

Administrative Office:

Telephone - (518)-584-9030 Ext 1020

Certificate Number: 201010971

135 South Broadway, , Saratoga Springs, New York 12866

Effective: 07/10/2020 10/31/2020

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)

Saratoga County Alcohol & Substance Abuse Services

Service Type:

Program Name:

Certified Capacity:PRU 50759

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10971_Sarato.pdf

The Saratoga Hospital

Mr. Angelo G. Calbone, President/CEO

1st Floor, 211 Church Street, Saratoga Springs, NY 12866

Provider Number: 87070

Administrative Office:

Telephone - (518)-587-3222

Certificate Number: 220712152

1st Floor, 24 Hamilton Street, Saratoga Springs, New York 12866

Effective: 09/21/2020 7/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Saratoga Community Health Center's Addiction Medicine Program

Service Type:

Program Name:

Certified Capacity:PRU 53269

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12152_Sarato.pdf

SCAN-New York Volunteer Parent-Aides Association, Inc.

Mr. Lewis Zuchman, Executive Director

Suite 301, 345 East 102nd Street, New York, NY 10029

Provider Number: 2035

Administrative Office:

Telephone - (212)-289-8030

Certificate Number: 210211338

Basement & 1st Floor, 1377 Jerome Avenue, Bronx, New York 10452

Effective: 03/01/2018 2/28/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7422

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

Mr. Joseph Gambino, Chief Executive Officer

1044 State Street, Schenectady, NY 12307

Provider Number: 51390

Administrative Office:

Telephone - (518)-370-1441 Ext 4126

January 31, 2022 Page 180 of 227

Certificate Number: 211212252

1044 State Street, , Schenectady, New York 12307

Effective: 01/04/2021 12/31/2021

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)

Hometown Health Centers

Service Type:

Program Name:

Certified Capacity:PRU 53493

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12252_Schene.pdf

Schoharie County Community Services Board

Ms. Bonnie L. Post, Director of Community Services

County Annex Building, Suite #1, 113 Park Place, PO Box 160, Schoharie, NY 12157

Provider Number: 70740

Administrative Office:

Telephone - (518)-295-8407

Certificate Number: 240510972

Schoharie County Annex Building, Suite #1, 113 Park Place, Schoharie, New York 12157

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Schoharie County Chemical Dependencies Clinic

Service Type:

Program Name:

Certified Capacity:PRU 50427

with Telepractice and Problem Gambling Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10972_Schoha.pdf

SCO Family of Services

Mr. Keith Little, Executive Director

1 Alexander Place, Glen Cove, NY 11542

Provider Number: 22270

Administrative Office:

Telephone - (516)-671-1253

Certificate Number: 240312177

2nd Floor, 151 Burrs Lane, , Dix Hills, New York 11746

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Morning Star I

20Service Type:

Program Name:

Certified Capacity:PRU 53316

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Certificate Number: 240312178

Freestanding Building - 1st Floor, Main Building - 2nd Floor, Morning Star II Expansion, 151 Burrs Lane, , Dix Hills, New York 11746

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Morning Star II

23Service Type:

Program Name:

Certified Capacity:PRU 53317

and up to 25 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12178_SCOFam.pdf

Certificate Number: 220712272

151 Burrs Lane, , Dix Hills, New York 11746

Effective: 08/23/2021 7/31/2022

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53029

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12272_SCOFam.pdf

January 31, 2022 Page 181 of 227

Certificate Number: 221012292

1 Alexander Place , , Glen Cove, New York 11542

Effective: 11/10/2021 10/31/2022

Program Location:

Establishment Anticipated Recert Review:

Community Psychiatric Support & Treatment (CPST)Service Type:

Program Name:

Certified Capacity:PRU 53605

Other Licensed PractitionersService Type:

Program Name:

Certified Capacity:PRU 53604

Psychosocial Rehabilitation (PSR)Service Type:

Program Name:

Certified Capacity:PRU 53603

Family Peer Support and ServicesService Type:

Program Name:

Certified Capacity:PRU 53601

Youth Peer Support and TrainingService Type:

Program Name:

Certified Capacity:PRU 53602

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12292_SCOFam

Seafield Center, Inc.

Mr. Mark Epley, CEO

7 Seafield Lane, Westhampton Beach, NY 11978

Provider Number: 18990

Administrative Office:

Telephone - (631)-288-1122 Ext 204

Certificate Number: 220411395

1st and 2nd Floors, 7 Seafield Lane, Westhampton Beach, New York 11978

Effective: 03/01/2021 4/30/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 100Service Type:

Program Name:

Certified Capacity:PRU 50893

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11395_Seafie.pdf

Seafield Services, Inc.

Mr. Mark Epley, Chief Executive Officer

7 Seafield Lane, Westhampton Beach, NY 11978

Provider Number: 17440

Administrative Office:

Telephone - (631)-288-1122

Certificate Number: 201110581

240 West Main Street, , Riverhead, New York 11901

Effective: 07/01/2020 11/30/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Seafield Riverhead

Service Type:

Program Name:

Certified Capacity:PRU 5830

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10581_Seafie.pdf

January 31, 2022 Page 182 of 227

Certificate Number: 221110582

1st & 2nd Floors, 37 John Street, Amityville, New York 11701

Effective: 07/01/2020 11/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Seafield Amityville

Service Type:

Program Name:

Certified Capacity:PRU 50895

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52961

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10582_Seafie.pdf

Certificate Number: 210910583

Basement, 1st and 2nd Floors, 110 Main Street, Mineola, New York 11501

Effective: 07/01/2020 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Seafield Mineola

Service Type:

Program Name:

Certified Capacity:PRU 51109

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10583_Seafie.pdf

Certificate Number: 231110977

Suite 101, 1st Floor, 475 East Main Street, East Patchogue, New York 11772

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Seafield Patchogue

Service Type:

Program Name:

Certified Capacity:PRU 7246

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10977_Seafie.pdf

Certificate Number: 231010978

Bldg. 9, 3251 Route 112, Medford, New York 11763

Effective: 11/01/2020 10/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Seafield Medford

Service Type:

Program Name:

Certified Capacity:PRU 51806

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10978_Seafie.pdf

Seneca County Community Services Board

Ms. Margaret Morse, Director of Community Services

31 Thurber Drive, Waterloo, NY 13165

Provider Number: 70330

Administrative Office:

Telephone - (315)-539-1985

Certificate Number: 231010984

31 Thurber Drive, Waterloo, New York 13165

Effective: 11/01/2020 10/31/2023

Program Location:

Renewal Anticipated Recert Review:OMH Host

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50431

with Problem Gambling Designation [with ancillary withdrawal services] with Telepractice Designation

January 31, 2022 Page 183 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10984_Seneca.pdf

Certificate Number: 240811986

31 Thurber Drive, Waterloo, New York 13165

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90731

with Telepractice Designation

Waterloo High School, 96 Stark Street, Waterloo, NY 13165

Other Service Site(s) At:

Waterloo Middle School, 65 Center 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:

South Seneca Middle/High School, 2nd Floor, North, Rooms W & M, 7263 Main Street, Ovid, NY 14521

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:

Frank Knight Elementary School, 1st Floor, Room 42, 98 Clinton Street, Seneca Falls, NY 13148

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:

La Fayette Elementary School, 2nd Floor, Room Adjacent to Room 211, 71 Inslee Street, Waterloo, NY 13165

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11986_Seneca.pdf

Senior Hope Counseling, Inc.

Nicole MacFarland Ph.D., Executive Director

2nd Floor, 650 Warren Street, Albany, NY 12208

Provider Number: 45240

Administrative Office:

Telephone - (518)-489-7777 Ext 102

Certificate Number: 221111589

2nd Floor, 650 Warren Street, , Albany, New York 12208

Effective: 12/01/2020 11/30/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52134

with Telepractice Designation

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

Ms. Donna Colonna, President and Chief Executive Officer

Palladia, Inc. as Operator, 17th Floor, 463 7th Avenue, New York, NY 10018

Provider Number: 39050

Administrative Office:

Telephone - (212)-633-6900

January 31, 2022 Page 184 of 227

Certificate Number: 211011885

2nd Floor, 177-185 East 122nd Street, New York, New York 10035

Effective: 11/01/2019 10/31/2021

Program Location:

Renewal Anticipated Recert Review:OASAS Host

Outpatient Service (822)

CTI Harlem

Service Type:

Program Name:

Certified Capacity:PRU 52857

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

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: 221112293

Basement-5th Floors, 1806-08 Third Avenue , , New York, New York 10029

Effective: 12/14/2021 11/30/2022

Program Location:

Establishment Anticipated Recert Review:

Residential Services (820) 72Service Type:

Program Name:

Certified Capacity:PRU 53609

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12293_Service.pdf

SES Operating Corp. d/b/a Harlem East Life Plan

Mr. Stuart R. Steiner, President, Executive Director

2369 Second Avenue, New York, NY 10035

Provider Number: 550

Administrative Office:

Telephone - (212)-876-2300 Ext 102

Certificate Number: 221010384

1st & 2nd Floors, 2369 Second Avenue, , New York, New York 10035

Effective: 07/03/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 500Service Type:

Program Name:

Certified Capacity:PRU 1474

with Telepractice Designation [with ancillary withdrawal services for up to 50 patients]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10384_SESOpe.pdf

Certificate Number: 221010385

1st & 2nd Floors, 2369 Second Avenue, , New York, New York 10035

Effective: 07/03/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 50Service Type:

Program Name:

Certified Capacity:PRU 7340

with Telepractice Designation - 50 of which are Key Extended Entry Program (KEEP) Patients [with ancillary withdrawal services for up to 50 patients]

Opioid Treatment Program (822) 500Service Type:

Program Name:

Certified Capacity:PRU 1473

with Telepractice Designation - 50 of which are Key Extended Entry Program (KEEP) Patients [with ancillary withdrawal services for up to 50 patients]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10385_SESOpe.pdf

January 31, 2022 Page 185 of 227

Certificate Number: 211211292

2369 Second Avenue, 3rd Floor, 2367 Second Avenue, 1st Floor, New York, New York 10035

Effective: 07/03/2020 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Harlem East Life Plan (HELP)

0Service Type:

Program Name:

Certified Capacity:PRU 51840

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11292_SESOpe.pdf

Shiloh Psychological Consulting PLLC

Kay Jackson Ph.D., Executive Director/Owner

4th Floor, 566 Seventh Avenue, New York, NY 10018

Provider Number: 50550

Administrative Office:

Telephone - 212-564-7631

Certificate Number: 200212160

4th Floor, 566 Seventh Avenue, , New York, New York 10018

Effective: 03/01/2019 2/29/2020

Program Location:

Establishment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53293

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Silver Lake Support Services, Inc.

Mr. Avraham Schick, Executive Director

201 Forest Avenue, Staten Island, NY 10301

Provider Number: 41860

Administrative Office:

Telephone - (718)-815-3155

Certificate Number: 220710987

1st & 2nd Floors, 201 Forest Avenue, , Staten Island, New York 10301

Effective: 08/22/2019 7/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 51829

with Telepractice Designation

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

Ms. Heather Loomis, VP Operations

2157 Main Street, Buffalo, NY 14214

Provider Number: 81820

Administrative Office:

Telephone - (716)-862-2378

Certificate Number: 210610408

158 Holden Street, , Buffalo, New York 14214

Effective: 07/31/2020 6/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 650Service Type:

Program Name:

Certified Capacity:PRU 409

with Telepractice Designation

Capacity Lifted

Opioid Medical Maintenance (822)Service Type:

Program Name:

Certified Capacity:PRU 7347

January 31, 2022 Page 186 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10408_Sister.pdf

Certificate Number: 210710409

1st Floor, 435 East Henrietta Road, , Rochester, New York 14620

Effective: 07/22/2020 7/20/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Treatment Program (822) 250Service Type:

Program Name:

Certified Capacity:PRU 6924

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10409_Sister.pdf

Certificate Number: 220310988

1st Floor, 210 John Glenn Drive, , Amherst, New York 14228

Effective: 07/10/2020 3/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Sisters Health Center Amherst

Service Type:

Program Name:

Certified Capacity:PRU 51018

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10988_Sister.pdf

Certificate Number: 210610992

1500 Broadway, Buffalo, New York 14212

Effective: 07/01/2018 6/30/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

STAR (Substance Treatment and Recovery) St. Vincent

Service Type:

Program Name:

Certified Capacity:PRU 51564

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10992_Sister.pdf

Certificate Number: 210912158

1st Floor, 210 John Glenn Drive, , Amherst, New York 14228

Effective: 08/10/2021 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Sisters Health Center Amherst

250Service Type:

Program Name:

Certified Capacity:PRU 53282

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12158_Sister.pdf

South Brooklyn Medical Administrative Services, Inc.

Ms. Alexis Bosco, Administrator & Chief Executive Officer

685 Third Avenue, Brooklyn, NY 11232

Provider Number: 553

Administrative Office:

Telephone - (718)-788-2594 Ext 117

Certificate Number: 221210387

685 3rd Avenue, Brooklyn, New York 11232

Effective: 01/01/2020 12/31/2022

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 450Service Type:

Program Name:

Certified Capacity:PRU 1479

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10387_SouthB.pdf

January 31, 2022 Page 187 of 227

South Richmond Hill Recovery, LLC

Mr. John J. Saith, Program Director

88-08 Liberty Avenue, Ozone Park, NY 11417

Provider Number: 49820

Administrative Office:

Telephone - (718)-785-3380 Ext 101

Certificate Number: 230212114

88-08 Liberty Avenue, , Ozone Park, New York 11417

Effective: 09/09/2020 2/28/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53167

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12114_SouthR.pdf

Southeast Nassau Guidance Center, Inc.

Milton Kalin Ph.D., Chief Executive Officer

2146 Jackson Avenue, P.O. Box 1037, Seaford, NY 11783

Provider Number: 50150

Administrative Office:

Telephone - (516)-679-9800

Certificate Number: 240710994

2nd Floor, 3375 Park Avenue, Wantagh, New York 11793

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 446

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10994_Southe.pdf

Certificate Number: 211110995

1st & 2nd Floor, 2146 Jackson Avenue, , Seaford, New York 11783

Effective: 06/22/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Chemical Dependence Counseling and Treatment

Service Type:

Program Name:

Certified Capacity:PRU 50473

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10995_Southe.pdf

Sports Foundation, Inc.

Akinshey X. Dorsett, Executive Director

871 Westchester Avenue, Bronx, NY 10459

Provider Number: 1613

Administrative Office:

Telephone - (718)-665-9585

Certificate Number: 200611975

Basement, 1st Floor Lobby, 871 Westchester Avenue, Bronx, New York 10459

Effective: 07/01/2018 6/30/2020

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90748

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11975_Sports.pdf

St. Barnabas Hospital

David Perlstein M.D., President and Chief Executive Officer

Administration - Braker Building, 4421 Third Avenue, Bronx, NY 10457

Provider Number: 81630

Administrative Office:

Telephone - (718)-960-6561

January 31, 2022 Page 188 of 227

Certificate Number: 220610234

Main Building, 4th Floor, 4422 Third Avenue, Bronx, New York 10457

Effective: 10/19/2020 6/30/2022

Program Location:

Amendment Anticipated Recert Review:

Medically Managed Withdrawal & Stabilization Services (816.6) 24Service Type:

Program Name:

Certified Capacity:PRU 50717

with Telepractice Designation [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10234_StBarn.pdf

Certificate Number: 231110406

4535 Third Avenue, , Bronx, New York 10458

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 660Service Type:

Program Name:

Certified Capacity:PRU 6962

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10406_StBarn.pdf

Certificate Number: 211010997

2nd floor, 4441-4451 Third Avenue, Bronx, New York 10457

Effective: 07/03/2020 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50718

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10997_StBarn.pdf

St. Charles Hospital, Port Jefferson, New York

Mr. James O'Connor, Executive Vice President and CEO

1st Floor, 200 Belle Terre Road, Port Jefferson, NY 11777

Provider Number: 82100

Administrative Office:

Telephone - (631)-474-6105

Certificate Number: 211111398

5 North and 5 South, 5th Floor, 200 Belle Terre Road, , Port Jefferson, New York 11777

Effective: 01/09/2019 11/17/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818) 40Service Type:

Program Name:

Certified Capacity:PRU 51415

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11398_StChar.pdf

Certificate Number: 211111839

2 North, 2nd Floor, 200 Belle Terre Road, , Port Jeffferson, New York 11777

Effective: 01/09/2019 11/17/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6) 20Service Type:

Program Name:

Certified Capacity:PRU 52754

[with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11839_StChar.pdf

January 31, 2022 Page 189 of 227

Certificate Number: 211111844

3 West, 3rd Floor, 200 Belle Terre Road, Port Jefferson, New York 11777

Effective: 01/09/2019 11/17/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6) 4Service Type:

Program Name:

Certified Capacity:PRU 52762

(adolescent) [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11844_StChar.pdf

St. Christopher's Inn, Inc.

James Schiller Ph.D., Executive Director

Box 150, 21 Franciscan Way, Garrison, NY 10524

Provider Number: 25360

Administrative Office:

Telephone - (845)-335-1009

Certificate Number: 240710564

21 Franciscan Way, Garrison, New York 10524

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51663

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51900

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10564_StChri.pdf

Certificate Number: 240811243

21 Franciscan Way, Garrison, New York 10524

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Outpatient Withdrawal & Stabilization (816.8)

St. Christopher's Inn

10Service Type:

Program Name:

Certified Capacity:PRU 8053

[without the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11243_StChri.pdf

Certificate Number: 231212183

13 Longview Avenue, , White Plains, New York 10605

Effective: 01/01/2021 12/31/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Brothers Christopher House

11Service Type:

Program Name:

Certified Capacity:PRU 53324

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12183_StChri.pdf

St. John's Riverside Hospital, Inc.

Mr. Ronald J. Corti, President and CEO

Andrus Pavilion, 967 North Broadway, Yonkers, NY 10701

Provider Number: 87150

Administrative Office:

Telephone - (914)-964-4221

January 31, 2022 Page 190 of 227

Certificate Number: 231211245

Wellness Center & Lab, 1st Floor, 2 Park Avenue, Yonkers, New York 10703

Effective: 03/07/2021 12/31/2023

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 400Service Type:

Program Name:

Certified Capacity:PRU 401

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11245_StJohn.pdf

Certificate Number: 220111247

North Wing, 3rd & 6th Floors North, 2 Park Avenue, Yonkers, New York 10703

Effective: 02/01/2019 1/31/2022

Program Location:

Renewal Anticipated Recert Review:

Medically Managed Withdrawal & Stabilization Services (816.6) 72Service Type:

Program Name:

Certified Capacity:PRU 50820

- with the use of methadone

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11247_StJohn.pdf

Certificate Number: 210711281

2nd Floor, 2 Park Avenue, Yonkers, New York 10703

Effective: 09/04/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

New Focus Center

Service Type:

Program Name:

Certified Capacity:PRU 51378

with Telepractice Designation

Outpatient Rehabilitation Service (822)

New Focus Center

Service Type:

Program Name:

Certified Capacity:PRU 51945

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11281_StJohn.pdf

Certificate Number: 240711283

1st Floor, 30 Manhattan Avenue, White Plains, New York 10607

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Greenburgh ATS

Service Type:

Program Name:

Certified Capacity:PRU 51687

with Telepractice Designation

Outpatient Rehabilitation Service (822)

Greenburgh ATS

Service Type:

Program Name:

Certified Capacity:PRU 51944

with Telepractice Designation

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

January 31, 2022 Page 191 of 227

Certificate Number: 240611284

1st Floor, 20 East First Street, Mount Vernon, New York 10550

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50638

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51947

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11284_StJohn.pdf

Certificate Number: 220111401

3rd Floor, West Wing, 5th Floor, North Wing, 3rd Floor, East Wing, 2 Park Avenue, Yonkers, New York 10703

Effective: 02/01/2019 1/31/2022

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 69Service Type:

Program Name:

Certified Capacity:PRU 51609

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11401_StJohn.pdf

St. Joseph’s Rehabilitation Center, Inc.

Mr. Robert Ross, Chief Executive Officer/President

159 Glenwood Drive, Saranac Lake, NY 12983

Provider Number: 35160

Administrative Office:

Telephone - (518)-891-3310 Ext 242

Certificate Number: 220210130

Building #1, and Family Building, 1st, 2nd & 3rd Floors, & 50 John Munn Road, 159 Glenwood Drive, , Saranac Lake, New York 12983

Effective: 10/19/2021 2/15/2022

Program Location:

Emergency Anticipated Recert Review:

d/b/a St. Joseph's Addiction Treatment and Recovery Centers

Inpatient Rehabilitation Service ( 818)

Chemical Dependence Rehabilitation

67Service Type:

Program Name:

Certified Capacity:PRU 50169

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10130_StJose.pdf

Certificate Number: 181210131

7 Fallkill Place, Poughkeepsie, New York 12601

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

d/b/a St. Joseph's Addiction Treatment and Recovery Centers

Supportive Living (819) 12Service Type:

Program Name:

Certified Capacity:PRU 51646

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10131_StJose.pdf

January 31, 2022 Page 192 of 227

Certificate Number: 231011003

50 John Munn Road , , Saranac Lake, New York 12983

Effective: 11/09/2021 10/31/2023

Program Location:

Amendment Anticipated Recert Review:

d/b/a St. Joseph's Addiction Treatment and Recovery Centers

Outpatient Service (822)

Robert R. Reiss Community Services Center

Service Type:

Program Name:

Certified Capacity:PRU 50171

with Telepractice and Problem Gambling Designations

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

Certificate Number: 211011004

458 East Main Street, Malone, New York 12953

Effective: 10/21/2020 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

d/b/a St. Joseph's Addiction Treatment and Recovery Centers

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50170

with Telepractice and Problem Gambling Designations

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

Certificate Number: 210111005

1st & 2nd Floors, 50 Montcalm Street, Ticonderoga, New York 12883

Effective: 04/16/2020 1/31/2021

Program Location:

Amendment Anticipated Recert Review:

d/b/a St. Joseph's Addiction Treatment and Recovery Centers

Outpatient Service (822)

Ticonderoga Chemical Dependence Outpatient Clinic

0Service Type:

Program Name:

Certified Capacity:PRU 50173

with Telepractice and Problem Gambling Designations

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

Certificate Number: 240512052

Floors 1-2, 444 Kiwassa Lake Road, Saranac Lake, New York 12983

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

d/b/a St. Joseph's Addiction Treatment and Recovery Centers

Residential Services (820)

Col. C. David Merkel, MD Veterans Residential Program

25Service Type:

Program Name:

Certified Capacity:PRU 53046

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12052_StJose.pdf

January 31, 2022 Page 193 of 227

Certificate Number: 240212067

100 County Route 43, Massena, New York 13662

Effective: 03/01/2021 2/29/2024

Program Location:

Renewal Anticipated Recert Review:

d/b/a Rose Hill

Residential Rehabilitation Services for Youth (817)

Rose Hill

Service Type:

Program Name:

Certified Capacity:PRU 53062

-- Rose Hill Young Adult Program 14 Beds -- Rose Hill Adolescent Program 14 Beds with Telepractice Designation

Residential Rehabilitation Services for Youth (817)

Rose Hill

28Service Type:

Program Name:

Certified Capacity:PRU 53063

-- Rose Hill Young Adult Program 14 Beds -- Rose Hill Adolescent Program 14 Beds with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12067_StJose.pdf

Certificate Number: 221112271

50 John Munn Road, , Saranac Lake, New York 12983

Effective: 12/29/2021 11/30/2022

Program Location:

Establishment Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

Robert R. Reiss Community Services Center

10Service Type:

Program Name:

Certified Capacity:PRU 53570

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

St. Joseph's Hospital, Yonkers

Mr. Michael J. Spicer, President & CEO

127 South Broadway, Yonkers, NY 10701

Provider Number: 81050

Administrative Office:

Telephone - (914)-378-7485

Certificate Number: 210310399

1st Floor, 317 South Broadway, Yonkers, New York 10705

Effective: 04/01/2018 3/31/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Opioid Treatment Program (822) 500Service Type:

Program Name:

Certified Capacity:PRU 400

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10399_StJose.pdf

Certificate Number: 210710633

2nd Floor, 317 South Broadway, Yonkers, New York 10705

Effective: 09/25/2019 7/28/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)

Positive Directions

0Service Type:

Program Name:

Certified Capacity:PRU 50874

with Telepractice Designation

Outpatient Rehabilitation Service (822)

Positive Directions

0Service Type:

Program Name:

Certified Capacity:PRU 51938

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10633_StJose.pdf

January 31, 2022 Page 194 of 227

Certificate Number: 231111733

3rd & 4th Floors, 175-20 Hillside Avenue, Jamaica, New York 11432

Effective: 11/11/2020 11/11/2023

Program Location:

Renewal Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Queens Opioid Treatment Clinic

800Service Type:

Program Name:

Certified Capacity:PRU 52569

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11733_StJose.pdf

Certificate Number: 221111736

211-221 Powell Street, , Brooklyn, New York 11212

Effective: 11/27/2019 11/27/2022

Program Location:

Renewal Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Powell Clinic

450Service Type:

Program Name:

Certified Capacity:PRU 52566

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11736_StJose.pdf

Certificate Number: 210711737

The Maxwell Institute Alcoholism Outpatient Clinic Program, 1st Floor, 92 Yonkers Avenue, Tuckahoe, New York 10707

Effective: 09/25/2019 7/28/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52563

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11737_StJose.pdf

Certificate Number: 230211738

1st and 2nd Floor, 480 Alabama Avenue, Brooklyn, New York 11207

Effective: 02/29/2020 2/28/2023

Program Location:

Renewal Anticipated Recert Review:Deemed

Opioid Treatment Program (822)

Alabama Clinic

700Service Type:

Program Name:

Certified Capacity:PRU 52570

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11738_StJose.pdf

Certificate Number: 210711741

Spellman Building, Ground Floor & 1st Floor, 275 North Street, , Harrison, New York 10528

Effective: 09/25/2019 7/28/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52564

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52565

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11741_StJose.pdf

January 31, 2022 Page 195 of 227

Certificate Number: 210711742

Spellman Building, 1st Floor, 275 North Street, , Harrison, New York 10528

Effective: 09/19/2018 7/28/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818) 30Service Type:

Program Name:

Certified Capacity:PRU 52559

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11742_StJose.pdf

Certificate Number: 210311835

1st Floor, 132 Pearl Street, Port Chester, New York 10573

Effective: 06/07/2019 3/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 52746

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11835_StJose.pdf

Certificate Number: 240112134

18 Spring Street, Port Chester, New York 10573

Effective: 02/01/2021 1/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

Sr. Anne Mary Regan Residence

20Service Type:

Program Name:

Certified Capacity:PRU 53228

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12134_StJose.pdf

St. Lawrence County Community Services Board

Mr. Jay Ulrich, Director of Community Services

Canton Human Services Center, Suite #1, 80 State Highway 310, Canton, NY 13617

Provider Number: 70700

Administrative Office:

Telephone - (315)-379-2276

Certificate Number: 221211007

2nd Floor, 80 State Highway 310, , Canton, New York 13617

Effective: 04/30/2021 12/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

St. Lawrence County Addictions Services Canton

0Service Type:

Program Name:

Certified Capacity:PRU 50188

with Telepractice Designation

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

2nd Floor, 206 Ford Street, , Ogdensburg, New York 13699

Effective: 04/30/2021 9/30/2023

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

St. Lawrence County Addiction Services Ogdensburg

0Service Type:

Program Name:

Certified Capacity:PRU 51417

with Telepractice Designation

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

January 31, 2022 Page 196 of 227

St. Mark's Place Institute For Mental Health, Inc.

Roman Pabis Ph.D., Executive Director

57 St. Mark's Place, New York, NY 10003

Provider Number: 15480

Administrative Office:

Telephone - (212)-982-3470 Ext 124

Certificate Number: 210611011

1st, 2nd and 3rd Floors, 57 St. Mark's Place, New York, New York 10003

Effective: 08/03/2020 6/30/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51582

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11011_StMark.pdf

St. Mary's Healthcare

Mr. Scott Bruce, President & CEO

427 Guy Park Avenue, Amsterdam, NY 12010

Provider Number: 85350

Administrative Office:

Telephone - (518)-841-7101

Certificate Number: 200210615

4th Floor, 4988 State Highway 30, , Amsterdam, New York 12010

Effective: 03/01/2019 2/29/2020

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822) 0Service Type:

Program Name:

Certified Capacity:PRU 50685

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10615_StMary.pdf

Certificate Number: 201110746

2nd and 3rd Floors, 73 North Main Street, Gloversville, New York 12078

Effective: 12/01/2018 11/30/2020

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52614

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10746_StMary.pdf

Certificate Number: 210811404

3rd Floor, 427 Guy Park Avenue, Amsterdam, New York 12010

Effective: 09/01/2018 8/31/2021

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 14Service Type:

Program Name:

Certified Capacity:PRU 51257

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11404_StMary.pdf

Certificate Number: 211011434

4th Floor, 4988 State Highway 30, , Amsterdam, New York 12010

Effective: 09/04/2020 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 100Service Type:

Program Name:

Certified Capacity:PRU 7404

with Telepractice Designation [with ancillary withdrawal services for up to 10 patients]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11434_StMary.pdf

January 31, 2022 Page 197 of 227

St. Peter's Health Partner's, as Sponsor St. Peter's Hospital of the City of Albany, as Operator

Mr. Patrick Carrese, Director

3 Mercycare Lane, Guilderland, NY 12084

Provider Number: 83060

Administrative Office:

Telephone - (518)-452-6707

Certificate Number: 210910254

Gabrilove Pavilion, 6th Floor, 315 South Manning Boulevard, Albany, New York 12208

Effective: 08/04/2020 9/22/2021

Program Location:

Establishment Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6) 18Service Type:

Program Name:

Certified Capacity:PRU 50227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10254_StPete.pdf

Certificate Number: 210710255

64 Second Avenue, Albany, New York 12202

Effective: 09/21/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Community Residential (819)

SPARC Halfway House

22Service Type:

Program Name:

Certified Capacity:PRU 50234

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10255_StPete.pdf

Certificate Number: 210910569

64 Second Avenue, Albany, New York 12202

Effective: 10/06/2020 9/22/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51920

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50233

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10569_StPete.pdf

Certificate Number: 210911017

2nd Floor, 845 Central Avenue, Albany, New York 12206

Effective: 10/06/2020 9/22/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)

SPARC

Service Type:

Program Name:

Certified Capacity:PRU 50232

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11017_StPete.pdf

Certificate Number: 210911018

55 Mohawk Street, Cohoes, New York 12047

Effective: 10/06/2020 9/22/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)

SPARC

Service Type:

Program Name:

Certified Capacity:PRU 50230

with Telepractice Designation [with ancillary withdrawal]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11018_StPete.pdf

January 31, 2022 Page 198 of 227

Certificate Number: 210911429

1st Floor, 2925 Hamburg Street, Rotterdam, New York 12303

Effective: 10/06/2020 9/22/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51810

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11429_StPete.pdf

Certificate Number: 210911430

125 High Rock Avenue, Saratoga Springs, New York 12866

Effective: 10/06/2020 9/22/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50928

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51925

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11430_StPete.pdf

Certificate Number: 210911431

636 New Loudon Road, Latham, New York 12110

Effective: 09/21/2020 9/22/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50927

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11431_StPete.pdf

Certificate Number: 210711463

1st & 2nd Floors, 3 Mercycare Lane, Guilderland, New York 12084

Effective: 09/21/2020 9/22/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

SPARC Inpatient Rehabilitation Program

40Service Type:

Program Name:

Certified Capacity:PRU 51039

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11463_StPete.pdf

Certificate Number: 210712116

Gabrilove Pavilion/Nolan Riddle, 6th Floor, 315 South Manning Boulevard, Albany, New York 12208

Effective: 09/21/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Medically Supervised Outpatient Withdrawal & Stabilization (816.8)

St. Peter's Hospital Detox

45Service Type:

Program Name:

Certified Capacity:PRU 53157

with Telepractice Designation

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

Mr. Michael Finegan, Chief Executive Officer

2215 Burdett Avenue, Troy, NY 12180

Provider Number: 81140

Administrative Office:

Telephone - (518)-525-1990

January 31, 2022 Page 199 of 227

Certificate Number: 210712169

4th Floor, 1300 Massachusetts Avenue, , Troy, New York 12180

Effective: 08/04/2020 7/31/2021

Program Location:

Establishment Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

St. Mary's Hospital Campus

20Service Type:

Program Name:

Certified Capacity:PRU 53306

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12169_Samari.pdf

Certificate Number: 210712170

Floor #4N, 1300 Massachusetts Avenue, , Troy, New York 12180

Effective: 08/04/2020 7/31/2021

Program Location:

Establishment Anticipated Recert Review:

Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 60Service Type:

Program Name:

Certified Capacity:PRU 53305

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12170_Samari.pdf

START Treatment & Recovery Centers, Inc.

Lawrence S. Brown M.D., Chief Executive Officer

937 Fulton Street, Brooklyn, NY 11238

Provider Number: 47570

Administrative Office:

Telephone - (718)-260-2917

Certificate Number: 230410353

1149-55 Myrtle Avenue, Brooklyn, New York 11206

Effective: 05/01/2021 4/30/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822)

ARTC Bushwick MMTP

500Service Type:

Program Name:

Certified Capacity:PRU 80

[with ancillary withdrawal services]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10353_STARTT.pdf

Certificate Number: 240810355

1st & 2nd Floors, 2191 Third Avenue, , New York, New York 10035

Effective: 09/01/2021 8/31/2024

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822)

Third Horizon Clinic

385Service Type:

Program Name:

Certified Capacity:PRU 77

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10355_STARTT.pdf

Certificate Number: 221010356

2nd and 3rd Floors, 2406 Amsterdam Avenue, , New York, New York 10033

Effective: 11/01/2020 10/31/2022

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 350Service Type:

Program Name:

Certified Capacity:PRU 1302

[with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10356_STARTT.pdf

January 31, 2022 Page 200 of 227

Certificate Number: 210710357

1st Floor, 494 Dumont Avenue, Brooklyn, New York 11207

Effective: 03/04/2021 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

East New York Clinic

500Service Type:

Program Name:

Certified Capacity:PRU 78

[with ancillary withdrawal services]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10357_STARTT.pdf

Certificate Number: 210310358

2nd and 3rd Floors, 937 Fulton Street, Brooklyn, New York 11238

Effective: 03/04/2021 3/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Fort Greene Clinic

500Service Type:

Program Name:

Certified Capacity:PRU 7

[with ancillary withdrawal services]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10358_STARTT.pdf

Certificate Number: 210311563

Basement, 4th and 5th Floors, 119-121 West 124th Street, New York, New York 10027

Effective: 03/04/2021 3/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Starting Point Clinic

300Service Type:

Program Name:

Certified Capacity:PRU 6

[with ancillary withdrawal services]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11563_STARTT.pdf

Certificate Number: 230311564

Basement, 2nd and 3rd Floors, 119-121 West 124th Street, New York, New York 10027

Effective: 03/04/2021 3/31/2023

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Kaleidoscope Clinic

300Service Type:

Program Name:

Certified Capacity:PRU 8

[with ancillary withdrawal services]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11564_STARTT.pdf

Certificate Number: 230711572

6th Floor, 119-121 West 124th Street, New York, New York 10027

Effective: 08/01/2021 7/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

REACH Program

Service Type:

Program Name:

Certified Capacity:PRU 52059

[with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11572_STARTT.pdf

State University of New York at Buffalo

Kenneth E. Leonard Ph.D., Director, Research Institute on Addictions

Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203

Provider Number: 30560

Administrative Office:

Telephone - (716)-887-2509

January 31, 2022 Page 201 of 227

Certificate Number: 211211025

Research Institute on Addictions, 1st and 2nd Floors, 1021 Main Street, Buffalo, New York 14203

Effective: 01/01/2020 12/31/2021

Program Location:

Renewal Anticipated Recert Review:

Chemical Dependency Specialized Services (824)

University at Buffalo's Addiction Treatment Services

Service Type:

Program Name:

Certified Capacity:PRU 52735

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11025_StateU.pdf

Steuben County Alcoholism and Substance Abuse Services

Henry Chapman Psy.D., Director

115 Liberty Street, Bath, NY 14810

Provider Number: 70640

Administrative Office:

Telephone - (607)-664-2156

Certificate Number: 220311030

4th Floor, 115 Liberty Street, Bath, New York 14810

Effective: 10/28/2020 3/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50913

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11030_Steube.pdf

Certificate Number: 240311031

114 Chestnut Street, Corning, New York 14830

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50914

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11031_Steube.pdf

Certificate Number: 220611658

1st Floor, 7454 Seneca Road, Hornell, New York 14843

Effective: 10/28/2020 6/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52186

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11658_Steube.pdf

Strong Memorial Hospital

Mr. Steven I. Goldstein, Chief Executive Officer

Room 1-4336, 601 Elmwood Avenue, Rochester, NY 14642

Provider Number: 87080

Administrative Office:

Telephone - (585)-275-7685

January 31, 2022 Page 202 of 227

Certificate Number: 210710465

2613 West Henrietta Road, , Rochester, New York 14623

Effective: 06/10/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Opioid Medical Maintenance (822)Service Type:

Program Name:

Certified Capacity:PRU 7365

Opioid Treatment Program (822) 500Service Type:

Program Name:

Certified Capacity:PRU 665

with Telepractice Designation [with ancillary withdrawal services for up to 50 patients]

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10465_Strong.pdf

Certificate Number: 220411095

Suite C & D, 2613 West Henrietta Road, , Rochester, New York 14623

Effective: 06/10/2020 4/6/2022

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Outpatient Service (822)

AYA (Adolescents/Young Adults)

0Service Type:

Program Name:

Certified Capacity:PRU 53464

withTelepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11095_Strong.pdf

Student Assistance Services Corporation

Ms. Ellen R. Morehouse, Executive Director

1st Floor, 660 White Plains Road, Tarrytown, NY 10591

Provider Number: 34310

Administrative Office:

Telephone - (914)-332-1300

Certificate Number: 220111978

1st Floor, 660 White Plains Road, Tarrytown, New York 10591

Effective: 09/01/2021 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Prevention Counseling

Student Assistance Services

Service Type:

Program Name:

Certified Capacity:PRU 90672

with Telepractice Designation

Saunders Trade and Technical High School, 183 Palmer Road, Yonkers, NY 10701

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:

Lakeland Copper Beach Middle School, 3401 Old Yorktown Road, Yorktown Heights, NY 10598

Other Service Site(s) At:

January 31, 2022 Page 203 of 227

Alexander Hamilton Junior/Senior High School, South Goodwin Avenue, Elmsford, NY 10523

Other Service Site(s) At:

Sleepy Hollow High School, 210 North Broadway, North Tarrytown, NY 10591

Other Service Site(s) At:

Horace Greeley High School D Building, 70 Roaring Brook Road, Chappaqua, NY 10514

Other Service Site(s) At:

Briarcliff Middle School, 444 Pleasantville Road, Briarcliff Manor, NY 10510

Other Service Site(s) At:

Yonkers Montessori Academy, 160 Woodlawn Avenue, Yonkers, NY 10704

Other Service Site(s) At:

Pierre Van Cortlandt Middle School, 3 Glen Place, Croton-on-Hudson, NY 10520

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:

Croton-Harmon High School, 36 Old Post Road South, Croton-on-Hudson, NY 10520

Other Service Site(s) At:

Byram Hills High School, 12 Tripp Lane, Armonk, NY 10504

Other Service Site(s) At:

New Rochelle High School, 265 Clove Road, New Rochelle, NY 10801

Other Service Site(s) At:

Roosevelt High School, 631 Tuckahoe Road, Yonkers, NY 10710

Other Service Site(s) At:

Yorktown High School, 2727 Crompond Road, Yorktown Heights, NY 10598

Other Service Site(s) At:

Walter Panas High School, 300 Croton Avenue, Cortland Manor, NY 10566

Other Service Site(s) At:

Pelham High School, 575 Colonial Avenue, Pelham, NY 10803

Other Service Site(s) At:

Hendrick Hudson High School, Albany Post Road, Montrose, NY 10548

Other Service Site(s) At:

White Plains Middle School/Highlands, 128 Grandview Avenue, White Plains, NY 10605

Other Service Site(s) At:

Somers High School, Route 139, Lincolndale, NY 10540

Other Service Site(s) At:

Yonkers High School, 150 Rockland Avenue, Yonkers, NY 10705

Other Service Site(s) At:

Ardsley Middle School, 700 Ashford Avenue, Ardsley, NY 10502

Other Service Site(s) At:

January 31, 2022 Page 204 of 227

Lakeland High School, 1349 East Main Street, Shrub Oak, NY 10588

Other Service Site(s) At:

Harrison High School, 255 Union Street, Harrison, NY 10528

Other Service Site(s) At:

Peekskill High School, 1072 Elm Street, Peekskill, NY 10566

Other Service Site(s) At:

Briarcliff High School, 445 Pleasantville Road, Briarclliff, NY 10510

Other Service Site(s) At:

Gorton High School, 100 Shonnard Place, Yonkers, NY 10703

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.

Mr. Douglas Terbeek, Executive Director

173 Lord Howe Street, Ticonderoga, NY 12883

Provider Number: 2185

Administrative Office:

Telephone - (518)-585-7424 Ext 101

Certificate Number: 240312007

173 Lord Howe Street, Ticonderoga, New York 12883

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90642

Lake Placid Junior/Senior High School, 4th Floor, Room 305, 34 School Street, Lake Placid, NY 12946

Other Service Site(s) At:

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:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12007_Substa.pdf

Success Counseling Services, Inc.

Mr Josh Greenfeld, CEO

1015 Ogden Avenue, Bronx, NY 10452

Provider Number: 29070

Administrative Office:

Telephone - (718)-538-6112

Certificate Number: 220411032

1015-1017 Ogden Avenue, , Bronx, New York 10452

Effective: 08/16/2021 4/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51788

with Telepractice Designation

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

Ms. Cari F. Besserman, Director

William J. Lindsay Complex - Bldg C016, 725 Veterans Memorial Highway, P.O. Box 6100, Hauppauge, NY 11788

Provider Number: 70370

Administrative Office:

Telephone - (631)-853-3108

January 31, 2022 Page 205 of 227

Certificate Number: 230310392

200 Wireless Boulevard, Hauppauge, New York 11788

Effective: 09/09/2020 3/31/2023

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 300Service Type:

Program Name:

Certified Capacity:PRU 3097

with Telepratice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10392_Suffol.pdf

Certificate Number: 211010393

2nd Floor, 300 Center Drive, Riverhead, New York 11901

Effective: 09/09/2020 10/31/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822)

Division of Community Mental Hygiene Services

275Service Type:

Program Name:

Certified Capacity:PRU 6731

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10393_Suffol.pdf

Certificate Number: 210210394

689 East Jericho Turnpike, Huntington Station, New York 11746

Effective: 09/09/2020 2/28/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 300Service Type:

Program Name:

Certified Capacity:PRU 202

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10394_Suffol.pdf

Certificate Number: 210910395

William J. Lindsay Complex, Building 151, 725 Veterans Memorial Highway, , Smithtown, New York 11787

Effective: 09/09/2020 9/30/2021

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 300Service Type:

Program Name:

Certified Capacity:PRU 201

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10395_Suffol.pdf

Sullivan County Department of Community Services

Ms. Melissa Stickle LCSW-R, CASAC, Director

20 Community Lane, PO Box 716, Liberty, NY 12754

Provider Number: 70170

Administrative Office:

Telephone - (845)-292-8770 Ext 2097

Certificate Number: 210610595

2nd Floor, 20 Community Lane, Liberty, New York 12754

Effective: 03/19/2019 6/30/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)

Sullivan County Alcohol and Drug Abuse Services

0Service Type:

Program Name:

Certified Capacity:PRU 50430

with telepractice designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10595_Sulliv.pdf

Syracuse Community Health Center, Inc.

Mr. Mark Hall, President & CEO

819 South Salina Street, Syracuse, NY 13202

Provider Number: 36260

Administrative Office:

Telephone - (315)-476-0642

January 31, 2022 Page 206 of 227

Certificate Number: 210511039

1st Floor, 819 South Salina Street, Syracuse, New York 13202

Effective: 06/01/2019 5/31/2021

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50934

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11039_Syracu.pdf

Syracuse Recovery Services, LLC

Ms. Lisa J. Forshee, Director

319 East Water Street, Syracuse, NY 13202

Provider Number: 47230

Administrative Office:

Telephone - (315)-282-5351

Certificate Number: 220911710

319 East Water Street, Syracuse, New York 13202

Effective: 07/01/2020 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52520

with Telepractice Designation

180 Genesee Street, Auburn, NY 13021

Additional Location(s) At:

Euclid Med Bldg, 1st Floor, Suite 5, 6 Euclid Avenue, Cortland, NY 13045

Additional Location(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11710_Syracu.pdf

T.R.I. Center, Inc.

Mr. Jose Gonzalez, President and CEO

1369 Broadway, New York, NY 10018

Provider Number: 16350

Administrative Office:

Telephone - (212)-268-8830

Certificate Number: 210711041

2nd and 3rd Floors, 1369 Broadway, New York, New York 10018

Effective: 07/01/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6015

with Telepractice Designation

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51959

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11041_TRICen.pdf

Certificate Number: 220111465

11th Floor, 175 Remsen Street, , Brooklyn, New York 11201

Effective: 04/12/2021 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6402

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11465_TRICen.pdf

January 31, 2022 Page 207 of 227

Certificate Number: 231211466

Suite 415-423, 2488 Grand Concourse, Bronx, New York 10458

Effective: 01/01/2021 12/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6134

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11466_TRICen.pdf

Tempo Group, Inc.

Ms. Cindy Wolff, Executive Director

112 Franklin Place, Woodmere, NY 11598

Provider Number: 313

Administrative Office:

Telephone - (516)-374-3671

Certificate Number: 200911043

112 Franklin Place, , Woodmere, New York 11598

Effective: 05/15/2020 9/30/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Woodmere Clinic

Service Type:

Program Name:

Certified Capacity:PRU 7066

with Telepractice Designation

23 Willis Avenue, Syosset, NY 11791

Additional Location(s) At:

1st Floor, 1260 Meadowbrook Road, North Merrick, NY 11566

Additional Location(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11043_TempoG.pdf

Certificate Number: 220712294

112 Franklin Place, , Woodmere, New York 11598

Effective: 08/01/2019 7/31/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention Counseling

Woodmere Clinic

Service Type:

Program Name:

Certified Capacity:PRU 90583

Merrick Middle School, 1st Floor, Social Worker's Office, 1870 Merrick Avenue, Merrick, NY 11566

Other Service Site(s) At:

John F. Kennedy High School, 1st Floor, Room 131, 3000 Bellmore Avenue, Bellmore, NY 11710

Other Service Site(s) At:

1st Floor, 1260 Meadowbrook Road, North Merrick, NY 11566

Other Service Site(s) At:

Grand Avenue Middle School, 1st Floor, Room 127, 2301 Grand Avenue, Bellmore, NY 11710

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:

Sanford H. Calhoun High School, 1st Floor, Room 113, 1786 State Street, Merrick, NY 11566

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/

Tioga County Community Services Board

Ms Lori Morgan, Director of Community Services

1062 State Route 38, P.O. Box 177, Owego, NY 13827

Provider Number: 70510

Administrative Office:

Telephone - (607)-689-8139

January 31, 2022 Page 208 of 227

Certificate Number: 211111080

1st Floor, 1062 NYS Route 38, , Owego, New York 13827

Effective: 06/22/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Tioga County Alcohol & Drug Services

Service Type:

Program Name:

Certified Capacity:PRU 554

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11080_TiogaC.pdf

Town of Babylon

Mr. Joseph Olmedo, Director

Babylon Town Hall, 1st Floor, 200 East Sunrise Highway, Lindenhurst, NY 11757

Provider Number: 372

Administrative Office:

Telephone - (631)-422-7676

Certificate Number: 231211544

281 Phelps Lane , North Babylon, New York 11703

Effective: 01/01/2021 12/31/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 560

with Telepractice Designation [with ancillary withdrawal services]

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

Mr Matthew Neebe, Executive Director

161 East Main Street, Smithtown, NY 11787

Provider Number: 667

Administrative Office:

Telephone - (631)-360-7578

Certificate Number: 220711084

161 East Main Street, Smithtown, New York 11787

Effective: 07/10/2020 7/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Horizons Counseling & Education Center

Service Type:

Program Name:

Certified Capacity:PRU 7116

with Telepractice Designation

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.

Mr. Harris Oberlander, Chief Executive Officer

15 Trinity Place, Albany, NY 12202

Provider Number: 24440

Administrative Office:

Telephone - (518)-449-5155 Ext 116

Certificate Number: 240212146

76-82 2nd Street, Albany, New York 12210

Effective: 03/01/2021 2/29/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 20Service Type:

Program Name:

Certified Capacity:PRU 53244

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12146_Trinit.pdf

January 31, 2022 Page 209 of 227

Triumph Treatment LLC

Mr. Edward Rebenwurzel, Managing Partner

2808 Avenue P, Brooklyn, NY 11229

Provider Number: 50670

Administrative Office:

Telephone - (347)-524-1832

Certificate Number: 200112168

2nd Floor, 309 West Park Avenue, , Long Beach, New York 11561

Effective: 02/01/2019 1/31/2020

Program Location:

Establishment Anticipated Recert Review:

Opioid Treatment Program (822) 25Service Type:

Program Name:

Certified Capacity:PRU 53303

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12168_Triump.pdf

The Tully Hill Corporation

s.. Cathy L. Palm, Executive Director

5821 State Route 80, P.O. Box 1116, Tully, NY 13159

Provider Number: 32611

Administrative Office:

Telephone - (315)-696-6114

Certificate Number: 221110102

5821 State Route 80, , Tully, New York 13159

Effective: 12/01/2019 11/30/2022

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)

The Tully Hill Corporation

8Service Type:

Program Name:

Certified Capacity:PRU 8050

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10102_TullyH.pdf

Certificate Number: 201211073

5821 State Route 80, , Tully, New York 13159

Effective: 03/03/2020 12/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

The Tully Hill Corporation

Service Type:

Program Name:

Certified Capacity:PRU 51660

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11073_TullyH.pdf

Certificate Number: 230111418

5821 State Route 80, , Tully, New York 13159

Effective: 02/01/2020 1/31/2023

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

The Tully Hill Corporation

42Service Type:

Program Name:

Certified Capacity:PRU 51062

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11418_TullyH.pdf

Twin County Recovery Services, Inc.

Ms. Karen Karl, Chief Administrator

350 Powers Avenue, Hudson, NY 12534

Provider Number: 35010

Administrative Office:

Telephone - 518-751-2083 Ext 1140

Certificate Number: 181210122

437-441 Columbia Street, Hudson, New York 12534

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

The Red Door Community Residence

13Service Type:

Program Name:

Certified Capacity:PRU 51164

with Telepractice Designation

January 31, 2022 Page 210 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10122_TwinCo.pdf

Certificate Number: 181210339

Grade Level, 428 West Main Street, Catskill, New York 12414

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Riverside Recovery Residence

12Service Type:

Program Name:

Certified Capacity:PRU 51765

[maximum certified occupancy can be no more than 16 persons] with Telepractice Designation

and up to 6 beds for children

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10339_TwinCo.pdf

Certificate Number: 230611087

1st Floor, 428 West Main Street, Catskill, New York 12414

Effective: 07/01/2021 6/30/2023

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6865

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11087_TwinCo.pdf

Certificate Number: 220111088

350 Power Avenue, Hudson, New York 12534

Effective: 09/09/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50146

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11088_TwinCo.pdf

Certificate Number: 240511981

Administrative Site Only:, 388 Main Street, , Catskill, New York 12414

Effective: 06/01/2021 5/31/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90675

with Telepractice Designation

Coxsackie-Athens School, 1st Floor, Counselor's Suite, 24 Sunset Boulevard, Coxsackie, NY 12051

Other Service Site(s) At:

Cairo-Durham CSD, High School Main Office, 1301 Route 145, Cairo, NY 12413

Other Service Site(s) At:

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11981_TwinCo.pdf

Unitas Therapeutic Community, Inc.

Ian S. Amritt Ph.D., Executive Director

4th Floor, 830 Southern Boulevard, Bronx, NY 10459

Provider Number: 1537

Administrative Office:

Telephone - (718)-589-0551 Ext 1005

Certificate Number: 220811980

St. Athanasius School, 830 Southern Boulevard, Bronx, New York 10459

Effective: 09/01/2019 8/31/2022

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90746

January 31, 2022 Page 211 of 227

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.

Steven Matteo, Chief Executive Officer

Building P, 3rd Floor, 1000 Richmond Terrace, Staten Island, NY 10301

Provider Number: 1786

Administrative Office:

Telephone - 917-975-5541

Certificate Number: 240312033

Administrative Site Only:, Building P, Floor #3, 1000 Richmond Terrace, Staten Island, New York 10301

Effective: 04/01/2021 3/31/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention CounselingService Type:

Program Name:

Certified Capacity:PRU 90749

P.S. 4, 1st Floor, Room 123, 200 Nedra Lane, Staten Island, NY 10312

Other Service Site(s) At:

I.S. 72, 1st Floor, Room 128, 33 Ferndale Avenue, Staten Island, NY 10314

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. 51, 2nd Floor, Room 254, 20 Houston Street, 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:

PS 55, 54 Osborne Avenue, Staten Island, NY 10302

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. 52, 1st Floor, Room 121, 480 Buel Avenue, Staten Island, NY 10305

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. 75, 1st Floor, Room 111, 455 Huguenot Avenue, Staten Island, NY 10312

Other Service Site(s) At:

I.S. 24, 1st Floor, Counseling Room, 225 Cleveland Avenue, Staten Island, NY 10308

Other Service Site(s) At:

PS 20, 161 Park Avenue, Staten Island, NY 10302

Other Service Site(s) At:

I.S. 34, 3rd Floor, Room 4037, 528 Academy Avenue, Staten Island, NY 10307

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:

I.S. 7, 1st Floor, Room 136, 1270 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:

January 31, 2022 Page 212 of 227

P.S. 19, 1st Floor, Room 105, 780 Post Avenue, Staten Island, NY 10310

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.

Mr. John J. Carrigg, President and Chief Executive Officer

10-42 Mitchell Avenue, Binghamton, NY 13903

Provider Number: 85330

Administrative Office:

Telephone - (607)-762-2260

Certificate Number: 231110451

Binghamton General Hospital, Ground Level, 10-42 Mitchell Avenue, Binghamton, New York 13903

Effective: 12/01/2020 11/30/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 150Service Type:

Program Name:

Certified Capacity:PRU 691

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10451_United.pdf

Certificate Number: 220111094

Binghamton General Hospital, 2nd Floor, 10-42 Mitchell Avenue, Binghamton, New York 13903

Effective: 05/28/2020 1/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

New Horizons Chemical Dependency Treatment Center

Service Type:

Program Name:

Certified Capacity:PRU 50599

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11094_United.pdf

Certificate Number: 211211421

Binghamton General Hospital, Memorial 4, 10-42 Mitchell Avenue, Binghamton, New York 13903

Effective: 05/28/2020 12/8/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

New Horizons Chemical Dependency Treatment Center

20Service Type:

Program Name:

Certified Capacity:PRU 50598

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11421_United.pdf

United Memorial Medical Center

Ms. Mandy Teeter, Vice President, Rochester Regional Health-Behavioral Health

127 North Street, Batavia, NY 14020

Provider Number: 82230

Administrative Office:

Telephone -

Certificate Number: 231011857

2nd Floor, 16 Bank Street, Batavia, New York 14020

Effective: 10/03/2020 10/3/2023

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

Hope Haven

22Service Type:

Program Name:

Certified Capacity:PRU 50957

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11857_United.pdf

January 31, 2022 Page 213 of 227

The Unity Hospital of Rochester

Ms. Mandy Teeter, Vice President, Rochester Regional Health-Behavioral Health

Evelyn Brandon Health Center, 3rd Floor, 81 Lake Avenue, Rochester, NY 14608

Provider Number: 83250

Administrative Office:

Telephone - (585)-368-6989

Certificate Number: 210510517

Chemical Dependency Building, 1565 Long Pond Road, Rochester, New York 14626

Effective: 09/10/2020 5/12/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 9Service Type:

Program Name:

Certified Capacity:PRU 8043

[without the use of methadone] with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10517_UnityH.pdf

Certificate Number: 220210921

Chemical Dependency Building, 1565 Long Pond Road, Rochester, New York 14626

Effective: 09/10/2020 2/28/2022

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50762

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10921_UnityH.pdf

Certificate Number: 220110922

Building 2, 1st Floor, 2000 Winton Road South, , Rochester, New York 14618

Effective: 08/04/2021 1/31/2022

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 50764

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10922_UnityH.pdf

Certificate Number: 230210923

2nd Floor, 81 Lake Avenue, Rochester, New York 14608

Effective: 03/01/2020 2/28/2023

Program Location:

Renewal Anticipated Recert Review:Deemed

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51607

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10923_UnityH.pdf

Certificate Number: 210511391

Chemical Dependency Building, 1565 Long Pond Road, Rochester, New York 14626

Effective: 09/10/2020 5/12/2021

Program Location:

Amendment Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818) 40Service Type:

Program Name:

Certified Capacity:PRU 50904

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11391_UnityH.pdf

Unity House of Cayuga County, Inc.

Ms. Elizabeth Smith, Executive Director

Administrative Offices only, Suite 14, 217 Genesee Street, Auburn, NY 13021

Provider Number: 23570

Administrative Office:

Telephone - (315)-253-6227 Ext 320

January 31, 2022 Page 214 of 227

Certificate Number: 181210067

58 Osborne Street, Auburn, New York 13021

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819)

Unity House

19Service Type:

Program Name:

Certified Capacity:PRU 51701

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10067_UnityH.pdf

Certificate Number: 181210068

58 Osborne Street, Auburn, New York 13021

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Grace House

16Service Type:

Program Name:

Certified Capacity:PRU 51176

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10068_UnityH.pdf

University Hospital - Stony Brook Eastern Long Island Hospital

Ms. Carol Gomes, Interim Chief Executive Officer

Room 221, Level 4, 101 Nicolls Road, Stony Brook, NY 11794

Provider Number: 81310

Administrative Office:

Telephone - (631)-444-2701

Certificate Number: 200610227

2nd Floor, 201 Manor Place, , Greenport, New York 11944

Effective: 08/06/2019 6/30/2020

Program Location:

Amendment Anticipated Recert Review:Deemed

Medically Managed Withdrawal & Stabilization Services (816.6)

Quannacut Detoxification Unit at Stony Brook Eastern Long Island Hospital

10Service Type:

Program Name:

Certified Capacity:PRU 51661

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10227_StonyB.pdf

Certificate Number: 200611053

905 East Main Street, , Riverhead, New York 11901

Effective: 05/29/2020 6/30/2020

Program Location:

Amendment Anticipated Recert Review:Deemed

Outpatient Service (822)

Stony Brook Medicine - Quannacut Outpatient Services

Service Type:

Program Name:

Certified Capacity:PRU 51122

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11053_Univer.pdf

Certificate Number: 200611411

2nd Floor, 201 Manor Place, , Greenport, New York 11944

Effective: 08/06/2019 6/30/2020

Program Location:

Amendment Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818)

Quannacut Inpatient Services at Stony Brook Eastern Long Island Hospital

20Service Type:

Program Name:

Certified Capacity:PRU 50845

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

Mr. Brian Durniok, President and Chief Executive Officer

207 Foote Avenue, P.O. Box 840, Jamestown, NY 14701

Provider Number: 81610

Administrative Office:

Telephone - (716)-664-8421

January 31, 2022 Page 215 of 227

Certificate Number: 240412054

2M Main Floor, 51 Glasgow Avenue, Jamestown, New York 14701

Effective: 05/01/2021 4/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

UPMC Chautauqua WCA OP

Service Type:

Program Name:

Certified Capacity:PRU 53048

with Telepractice Designation [with ancillary withdrawal services]

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

4th Floor, 207 Foote Avenue, Jamestown, New York 14701

Effective: 04/26/2018 1/27/2021

Program Location:

Renewal Anticipated Recert Review:Deemed

Inpatient Rehabilitation Service ( 818) 15Service Type:

Program Name:

Certified Capacity:PRU 53049

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12055_UPMCCH.pdf

Certificate Number: 230412204

4th Floor Main, 51 Glasgow Avenue, , Jamestown, New York 14701

Effective: 05/01/2021 4/30/2023

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820)

UPMC Behavioral Health Wellness Center

20Service Type:

Program Name:

Certified Capacity:PRU 53338

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12204_UPMCCh.pdf

Upper Manhattan Mental Health Center, Inc.

Mr. Thomas Haggerty Jr., Executive Director

1727 Amsterdam Avenue, New York, NY 10031

Provider Number: 70490

Administrative Office:

Telephone - (212)-694-9200

Certificate Number: 181210213

2009 3rd Avenue, New York, New York 10029

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819) 20Service Type:

Program Name:

Certified Capacity:PRU 51809

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10213_UpperM.pdf

Certificate Number: 210711097

3rd Floor, 1727 Amsterdam Avenue, New York, New York 10031

Effective: 06/22/2020 7/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Alcoholism & Substance Abuse Treatment Program

Service Type:

Program Name:

Certified Capacity:PRU 50962

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11097_UpperM.pdf

January 31, 2022 Page 216 of 227

Urban Recovery House LLC

Mr. Zev Friedman, Acting CEO

411 Van Brunt Street, Brooklyn, NY 11231

Provider Number: 50560

Administrative Office:

Telephone - (646)-960-6656

Certificate Number: 220112163

1st - 5th Floors, 411 Van Brunt Street, , Brooklyn, New York 11231

Effective: 02/01/2020 1/31/2022

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 30Service Type:

Program Name:

Certified Capacity:PRU 53294

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12163_UrbanR.pdf

Certificate Number: 211212175

1st Floor, 411 Van Brunt Street, , Brooklyn, New York 11231

Effective: 01/01/2020 12/31/2021

Program Location:

Renewal Anticipated Recert Review:

Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 6Service Type:

Program Name:

Certified Capacity:PRU 53295

with Telepractice Designation [with the use of methadone]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12175_UrbanR.pdf

VERTEX LLC

Mr. Paul Henderson, Executive Director

1080 East Gun Hill Road, Bronx, NY 10469

Provider Number: 44120

Administrative Office:

Telephone - (718)-653-1117

Certificate Number: 200811484

1st & 2nd Floors, 1080 East Gun Hill Road, Bronx, New York 10469

Effective: 01/01/2018 8/31/2020

Program Location:

Special ReIssue Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51992

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11484_VERTEX.pdf

Veterans Outreach Center, Inc.

Ms. Laura Stradley, Executive Director

459 South Avenue, Rochester, NY 14620

Provider Number: 43890

Administrative Office:

Telephone - (585)-295-7800

Certificate Number: 190711471

Administrative Site:, 290 Cypress Street, , Rochester, New York 14620

Effective: 11/09/2018 7/31/2019

Program Location:

Amendment Anticipated Recert Review:

Supportive Living (819) 6Service Type:

Program Name:

Certified Capacity:PRU 51991

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11471_Vetera.pdf

Vida Family Services, Inc.

Mr. Christopher Nazario, Executive Director

127 East 105th Street, New York, NY 10029

Provider Number: 1249

Administrative Office:

Telephone - (929)-300-4867 Ext 18

January 31, 2022 Page 217 of 227

Certificate Number: 221211100

127 East 105th Street, New York, New York 10029

Effective: 01/01/2021 12/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7179

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11100_VidaFa.pdf

Villa of Hope

Ms. Christina M. Gullo, Chief Executive Officer/President

3300 Dewey Avenue, Rochester, NY 14616

Provider Number: 37220

Administrative Office:

Telephone - (585)-865-1550 Ext 100

Certificate Number: 210411362

Building J, Room 202, 2nd Floor, 1099 Jay Street, Rochester, New York 14611

Effective: 09/01/2020 4/30/2021

Program Location:

Amendment Anticipated Recert Review:OMH Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51886

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11362_Villao.pdf

Certificate Number: 211211629

Life Residence, 3300 Dewey Avenue, , Rochester, New York 14616

Effective: 09/01/2020 12/31/2021

Program Location:

Amendment Anticipated Recert Review:

Residential Rehabilitation Services for Youth (817)

Life Program

14Service Type:

Program Name:

Certified Capacity:PRU 4856

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11629_Villao.pdf

Certificate Number: 220412265

3300 Dewey Avenue, , Rochester, New York 14616

Effective: 05/17/2021 4/30/2022

Program Location:

Establishment Anticipated Recert Review:

Community Psychiatric Support & Treatment (CPST)Service Type:

Program Name:

Certified Capacity:PRU 53552

Other Licensed PractitionersService Type:

Program Name:

Certified Capacity:PRU 53556

Psychosocial Rehabilitation (PSR)Service Type:

Program Name:

Certified Capacity:PRU 53553

Family Peer Support and ServicesService Type:

Program Name:

Certified Capacity:PRU 53554

Youth Peer Support and TrainingService Type:

Program Name:

Certified Capacity:PRU 53555

January 31, 2022 Page 218 of 227

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12265_Villao.pdf

Villa Veritas Foundation, Inc.

Ms. Suzanne Cusack, Executive Director

5 Ridgeview Road, Kerhonkson, NY 12446

Provider Number: 47750

Administrative Office:

Telephone - (845)-626-3555

Certificate Number: 220111752

5 Ridgeview Road, , Kerhonkson, New York 12446

Effective: 02/01/2020 1/31/2022

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 35Service Type:

Program Name:

Certified Capacity:PRU 52585

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11752_VillaV.pdf

Certificate Number: 190311864

5 Ridgeview Road, , Kerhonkson, New York 12446

Effective: 01/01/2018 3/31/2019

Program Location:

Special ReIssue Anticipated Recert Review:

Intensive Residential Rehabilitation (819) 50Service Type:

Program Name:

Certified Capacity:PRU 52803

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11864_VillaV.pdf

Village of Haverstraw Drug Abuse Prevention Council

Ms. Marion E. Breland, Executive Director

Haverstraw Center, 50 West Broad Street, Haverstraw, NY 10927

Provider Number: 1779

Administrative Office:

Telephone - (845)-429-5731 Ext 11

Certificate Number: 240911965

Village of Haverstraw Youth and Family/Community Center, 50 West Broad Street, Haverstraw, New York 10927

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention Counseling

Village of Haverstraw Drug Abuse Prevention Counseling

Service Type:

Program Name:

Certified Capacity:PRU 90633

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11965_Villag.pdf

Vocational Instruction Project Community Services, Inc.

Ms. Debbian Fletcher-Blake, Chief Executive Officer

6th Floor, 770 East 176th Street, Bronx, NY 10460

Provider Number: 325

Administrative Office:

Telephone - (718)-583-5150 Ext 8650

January 31, 2022 Page 219 of 227

Certificate Number: 201110366

1st & 3rd Floors, 770 East 176th Street, , Bronx, New York 10460

Effective: 10/15/2019 11/30/2020

Program Location:

Amendment Anticipated Recert Review:OASAS Host

Integrated Outpatient Services - PCService Type:

Program Name:

Certified Capacity:PRU

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Opioid Full Agonist Treatment Program (822) 1000Service Type:

Program Name:

Certified Capacity:PRU 670

with Telepractice Designation [with ancillary withdrawal services for up to 100 patients]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10366_Vocati.pdf

Certificate Number: 200511287

4th Floor, 770 East 176th Street, , Bronx, New York 10460

Effective: 10/15/2019 5/31/2020

Program Location:

Conditional Certificate Anticipated Recert Review:OASAS Host

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 6868

with Telepractice Designation [with ancillary withdrawal services]

Integrated Outpatient Services - PCService Type:

Program Name:

Certified Capacity:PRU

Integrated Outpatient Services - MHService Type:

Program Name:

Certified Capacity:PRU

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11287_Vocati.pdf

Certificate Number: 241012045

716 Fairmount Place, Bronx, New York 10457

Effective: 11/01/2021 10/31/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 40Service Type:

Program Name:

Certified Capacity:PRU 53043

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12045_Vocati.pdf

Certificate Number: 241112046

764 East 176th Street, Bronx, New York 10460

Effective: 12/01/2021 11/30/2024

Program Location:

Renewal Anticipated Recert Review:

Residential Services (820) 80Service Type:

Program Name:

Certified Capacity:PRU 53042

with Telepractice Designation

Elements: Stabilization Rehabilitation Reintegration Congregate Scattered

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12046_Vocati.pdf

January 31, 2022 Page 220 of 227

Volunteers of America - Greater New York, Inc.

Ms. Terre Pettitt, President and Chief Executive Officer

340 West 85th Street, New York, NY 10024

Provider Number: 22790

Administrative Office:

Telephone - (212)-496-4300

Certificate Number: 181210066

395 Webster Avenue, New Rochelle, New York 10801

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Community Residential (819)

Crossroads

17Service Type:

Program Name:

Certified Capacity:PRU 51043

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10066_Volunt.pdf

Wayne County Community Services Board

Mr. James M. Haitz LCSW-R, Director of Community Services

1519 Nye Road, Lyons, NY 14489

Provider Number: 70540

Administrative Office:

Telephone - (315)-946-5722

Certificate Number: 221011102

Rooms 113-120, 122-123A, 148, 149, 149A-149F, 198 & 199, 1st Floor, 1519 Nye Road, , Lyons, New York 14489

Effective: 05/15/2020 10/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Wayne Substance Abuse Services

Service Type:

Program Name:

Certified Capacity:PRU 4168

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11102_WayneC.pdf

WellLife Network Inc.

Ms. Sherry Tucker, Chief Executive Officer

142-02 20th Avenue, Flushing, NY 11351

Provider Number: 21920

Administrative Office:

Telephone - (718)-559-0518

Certificate Number: 240612021

234 Long Island Avenue, Wyandanch, New York 11798

Effective: 07/01/2021 6/30/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52975

with Telepractice and Problem Gambling Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12021_PSCHin.pdf

Certificate Number: 240712022

2nd Floor, 11 Route 111, , Smithtown, New York 11787

Effective: 08/01/2021 7/31/2024

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)

Addiction Recovery Services (ARS)

0Service Type:

Program Name:

Certified Capacity:PRU 52976

[with ancillary withdrawal] and Telepractice and Problem Gambling Designations

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

January 31, 2022 Page 221 of 227

Certificate Number: 200912023

Room #s 6, 63 and 64, 1st Floor, 55 Horizon Drive, Huntington, New York 11743

Effective: 07/01/2020 9/30/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 52977

[with ancillary withdrawal] and Telepractice and Problem Gambling Designations

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12023_PSCHIn.pdf

West Midtown Management Group, Inc.

Ms. Lydia Schorr Silverman, President

Suite 404, 505 Eighth Avenue, New York, NY 10018

Provider Number: 29520

Administrative Office:

Telephone - (212)-643-8811 Ext 300

Certificate Number: 240610365

5th & 6th Floors-Medical Services Only, 1st, 2nd, 3rd, 4th Floors, 311 West 35th Street, , New York, New York 10001

Effective: 10/01/2021 6/30/2024

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 1000Service Type:

Program Name:

Certified Capacity:PRU 1483

with Telepractice Designation

Capacity Lifted

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10365_WestMi.pdf

Certificate Number: 201011288

Rooms 417-421, 423-433, 435, 442, 444-446, 4th Floor, 505 Eighth Avenue, , New York, New York 10018

Effective: 07/03/2020 10/31/2020

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51843

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

Mr. Michael E. Doyle, Executive Director&Chief Medical Officer

HealthAlliance Hospital Broadway Campus as Operator, 396 Broadway, Kingston, NY 12401

Provider Number: 83190

Administrative Office:

Telephone -

Certificate Number: 220310591

10 Barbarossa Lane, Kingston, New York 12401

Effective: 04/01/2020 3/31/2022

Program Location:

Renewal Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51244

Outpatient Rehabilitation Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51923

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

January 31, 2022 Page 222 of 227

Certificate Number: 230911585

2 Barbarossa Lane, Kingston, New York 12401

Effective: 10/01/2020 9/30/2023

Program Location:

Renewal Anticipated Recert Review:

Opioid Treatment Program (822) 200Service Type:

Program Name:

Certified Capacity:PRU 52106

Capacity Lifted

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

Mr. Michael Doyle, Interim Executive Director

HealthAlliance Hospital Mary's Avenue Campus as Operator, 105 Mary's Avenue, Kingston, NY 12401

Provider Number: 81410

Administrative Office:

Telephone - (845)-334-2750

Certificate Number: 230311704

Spellman Building, Room #s 1402, 1403, and 1414, 1st Floor, 105 Mary's Avenue, , Kingston, New York 12401

Effective: 04/01/2020 3/31/2023

Program Location:

Renewal Anticipated Recert Review:

Medically Managed Withdrawal & Stabilization Services (816.6)

First Step

10Service Type:

Program Name:

Certified Capacity:PRU 52517

- 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]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11704_Westch.pdf

Certificate Number: 230311705

Spellman Building, Room #s 1402, 1403, and 1414, 1st Floor, 105 Mary's Avenue, , Kingston, New York 12401

Effective: 04/01/2020 3/31/2023

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818)

First Step

10Service Type:

Program Name:

Certified Capacity:PRU 52518

[up to 4 of these beds may be used for the provision of Section 816.6 medically managed withdrawal & stabilization services]

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

Mr. Michael D. Israel, President and CEO

Mid-Hudson Valley Division of Westchester Medical Center as Operator, 100 Woods Road, Valhalla, NY 10595

Provider Number: 87140

Administrative Office:

Telephone - (914)-493-7017

Certificate Number: 241011841

Spellman Building-5th Floor, Thorne Building-4th Floor, 241 North Road, Poughkeepsie, New York 12601

Effective: 11/01/2021 10/31/2024

Program Location:

Renewal Anticipated Recert Review:

Inpatient Rehabilitation Service ( 818) 50Service Type:

Program Name:

Certified Capacity:PRU 52760

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11841_Westch.pdf

January 31, 2022 Page 223 of 227

Certificate Number: 220811842

201 South Avenue, Executive Parks, Poughkeepsie, New York 12601

Effective: 09/01/2021 8/31/2022

Program Location:

Conditional Certificate Anticipated Recert Review:

Outpatient Service (822)

Turning Point

Service Type:

Program Name:

Certified Capacity:PRU 52759

with Telepractice Designation

Outpatient Rehabilitation Service (822)

Turning Point

Service Type:

Program Name:

Certified Capacity:PRU 52758

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11842_Westch.pdf

Certificate Number: 221111843

Spellman Building, 4th and 5th Floors, 241 North Road, , Poughkeepsie, New York 12601

Effective: 12/01/2019 11/30/2022

Program Location:

Renewal Anticipated Recert Review:

Medically Managed Withdrawal & Stabilization Services (816.6) 10Service Type:

Program Name:

Certified Capacity:PRU 52761

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11843_Westch.pdf

Westfall Associates, Inc.

Mr. Charles Montante, President

Building B, Suite 60, 919 Westfall Road, Rochester, NY 14618

Provider Number: 85059

Administrative Office:

Telephone - (585)-473-1500 Ext 213

Certificate Number: 210311105

Building B, Suite 60, 1st Floor, 919 Westfall Road, Rochester, New York 14618

Effective: 06/03/2020 3/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51102

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11105_Westfa.pdf

Whitney M. Young, Jr. Health Center, Inc.

Mr. David Shippee, Chief Executive Officer

920 Lark Drive, Albany, NY 12207

Provider Number: 35200

Administrative Office:

Telephone - (518)-465-4771

Certificate Number: 220910369

1st & 2nd Floors, 10 DeWitt Street, Albany, New York 12207

Effective: 02/18/2021 9/30/2022

Program Location:

Amendment Anticipated Recert Review:

Opioid Treatment Program (822) 350Service Type:

Program Name:

Certified Capacity:PRU 1631

Capacity Lifted

Opioid Medical Maintenance (822) 0Service Type:

Program Name:

Certified Capacity:PRU 53011

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10369_Whitne.pdf

January 31, 2022 Page 224 of 227

Certificate Number: 220110598

2nd Floor, 10 DeWitt Street, , Albany, New York 12207

Effective: 01/06/2022 5/7/2022

Program Location:

Emergency Anticipated Recert Review:

Outpatient Service (822)

F.A.C.T.S.

Service Type:

Program Name:

Certified Capacity:PRU 50855

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10598_Whitne.pdf

Wholeview Wellness, LLC

Sarah Church Ph.D., CEO/Executive Director

Suite 14A, 14th Floor, 369 Lexington Avenue, New York, NY 10017

Provider Number: 50840

Administrative Office:

Telephone - (212)-204-8430

Certificate Number: 201012211

Suite 14A, 14th Floor, 369 Lexington Avenue, , New York, New York 10017

Effective: 11/01/2019 10/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 53321

with Telepractice Designation [with ancillary withdrawal services]

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12211_Wholev.pdf

The William George Agency for Children's Services, Inc.

Ms. Helen Hulings, Executive Director

380 Freeville Road, Freeville, NY 13068

Provider Number: 11710

Administrative Office:

Telephone - (607)-844-6243

Certificate Number: 210811566

Van Clef Building, 1st, 2nd, & 3rd Floors, 380 Freeville Road, Freeville, New York 13068

Effective: 05/28/2020 8/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 51772

with Telepractice Designation

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

Ms. Stacey Spata, Executive Director

Suite 6, 1150 Portion Road, Holtsville, NY 11742

Provider Number: 352

Administrative Office:

Telephone - (631)-580-7777 Ext 104

Certificate Number: 220511543

Suite 6, 1150 Portion Road, Holtsville, New York 11742

Effective: 10/02/2020 5/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Family Services

Service Type:

Program Name:

Certified Capacity:PRU 1203

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11543_YoungM.pdf

Young Men's Christian Association of Greater New York

Ms. Jacqueline Filis, Executive Director

3911 Richmond Avenue, Staten Island, NY 10312

Provider Number: 20860

Administrative Office:

Telephone - (718)-948-3232

January 31, 2022 Page 225 of 227

Certificate Number: 211111111

3911 Richmond Avenue, Staten Island, New York 10312

Effective: 06/10/2020 11/30/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Staten Island YMCA Counseling Service

Service Type:

Program Name:

Certified Capacity:PRU 7209

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11111_YoungM.pdf

Certificate Number: 220511760

1st Floor, 285 Vanderbilt Avenue, Staten Island, New York 10304

Effective: 06/10/2020 5/31/2022

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)

Staten Island YMCA Counseling Service

Service Type:

Program Name:

Certified Capacity:PRU 52604

with Telepractice Designation

Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11760_YoungM.pdf

Certificate Number: 240911970

3911 Richmond Avenue, Staten Island, New York 10312

Effective: 10/01/2021 9/30/2024

Program Location:

Renewal Anticipated Recert Review:

Prevention Counseling

Staten Island Branch

Service Type:

Program Name:

Certified Capacity:PRU 90765

with Telepractice Designation

Prevention Counseling, 285 Vanderbilt Avenue, Staten Island, NY 10304

Other Service Site(s) At:

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.

Ms. Myra Henry, President and Chief Executive Officer

175 North Clinton Avenue, Rochester, NY 14604

Provider Number: 10940

Administrative Office:

Telephone - (585)-368-2280

Certificate Number: 181210008

175 North Clinton Avenue, Rochester, New York 14604

Effective: 01/01/2018 12/31/2018

Program Location:

Special ReIssue Anticipated Recert Review:

Supportive Living (819)

Steppingstone Supportive Living

29Service Type:

Program Name:

Certified Capacity:PRU 51479

with Telepractice Designation

and up to 46 beds for children

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.

Ms. Barbara Rakusin, Executive Director

193A South Street, Oyster Bay, NY 11771

Provider Number: 358

Administrative Office:

Telephone - (516)-922-6867

January 31, 2022 Page 226 of 227

Certificate Number: 201211549

193A South Street, , Oyster Bay, New York 11771

Effective: 08/25/2020 12/31/2020

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 682

with Telepractice Designation

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

Ms. Adrienne LoPresti, Executive Director

75 Grand Avenue, Massapequa, NY 11758

Provider Number: 1380

Administrative Office:

Telephone - (516)-799-3203

Certificate Number: 210111229

75 Grand Avenue, Massapequa, New York 11758

Effective: 06/22/2020 1/31/2021

Program Location:

Amendment Anticipated Recert Review:

Outpatient Service (822)Service Type:

Program Name:

Certified Capacity:PRU 7115

with Telepractice Designation

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

January 31, 2022 Page 227 of 227