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NPI Code Detail

MEDICARE: UPPER ROOM AIDS MINISTRY, INC. ADULT DAY HEALTH CARE CENTER.

MEDICARE: UPPER ROOM AIDS MINISTRY, INC. ADULT DAY HEALTH CARE CENTER.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA0600XAdult Day Care Clinic/Center
2261QF0050XNon-Surgical Family Planning Clinic/Center
31223G0001XGeneral Practice Dentistry
42084P0800XPsychiatry Physician
5251S00000XCommunity/Behavioral Health Agency
6103TC0700XClinical Psychologist
7104100000XSocial Worker
81041C0700XClinical Social Worker
9261QF0400XFederally Qualified Health Center (FQHC)
10261QP1100XPodiatric Clinic/Center
11363LP0808XPsychiatric/Mental Health Nurse Practitioner
12261Q00000XClinic/Center

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A100140369OTHERNYMEDICARE PART B
333/1040 AND 33/1041OTHERNYMEDICARE PART A

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417986340
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPPER ROOM AIDS MINISTRY, INC. ADULT DAY HEALTH CARE CENTER.
Provider Business Mailing Address
First Line : 306 LENOX AVENUE
Second Line : 3RD FLOOR
City : NEW YORK
State : NY
Zip : 10027-4920
Country : US
Telephone Number : 212-803-2850
Fax Number : 212-803-2899
Provider Business Practice Location Address
First Line : 169 W 133RD ST
Second Line :
City : NEW YORK
State : NY
Zip : 10030-3301
Country : US
Telephone Number : 646-762-4950
Fax Number : 646-762-4953
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TAMISHA MCPHERSON
Credential : MBA
Telephone Number : 212-803-2850
Provider Enumeration Date : 07/02/2006
Last Update Date : 09/05/2019

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