MEDICARE: CHARLES A. WALBURG MULTI-SERVICE ORGANIZATION, 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	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1730395468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES A. WALBURG MULTI-SERVICE ORGANIZATION, INC.

Provider Business Mailing Address
First Line	:	163 W 125TH ST
Second Line	:	ROOM 1320
City	:	NEW YORK
State	:	NY
Zip	:	10027-4436
Country	:	US
Telephone Number	:	212-222-2552
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 W 125TH ST
Second Line	:	ROOM 1320
City	:	NEW YORK
State	:	NY
Zip	:	10027-4436
Country	:	US
Telephone Number	:	212-222-2552
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. CARLA D. BROWN
Credential	:	MPA
Telephone Number	:	212-222-2552

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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