MEDICARE: OUR HOLDING SPACE LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1588465512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR HOLDING SPACE LLC

Provider Business Mailing Address
First Line	:	418 BROADWAY STE R
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-2922
Country	:	US
Telephone Number	:	862-591-3252
Fax Number	:	347-786-6534

Provider Business Practice Location Address
First Line	:	418 BROADWAY STE R
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-2922
Country	:	US
Telephone Number	:	678-644-4818
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANA DENARIS
Credential	:	PMHNP
Telephone Number	:	862-591-3252

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	04/18/2026

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Directions to “OUR HOLDING SPACE LLC ” Practice Location

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