MEDICARE: SELFHELP COMMUNITY SERVICES, INC

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	261QA0600X	Adult Day Care Clinic/Center
2	251E00000X	Home Health Agency	0308L003	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1699840967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELFHELP COMMUNITY SERVICES, INC

Provider Business Mailing Address
First Line	:	520 EIGHTH AVENUE
Second Line	:	5TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10018-6553
Country	:	US
Telephone Number	:	212-971-7000
Fax Number	:	212-629-9482

Provider Business Practice Location Address
First Line	:	520 EIGHTH AVENUE
Second Line	:	5TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10018-6553
Country	:	US
Telephone Number	:	212-971-7000
Fax Number	:	212-629-9482

Authorized Official
Title or Position	:	VICE PRESIDENT, ADMINISTRATION
Name	:	MR. RUSSELL LUSAK
Credential	:
Telephone Number	:	212-971-7707

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	03/22/2011

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