Healthcare Provider Details

I. General information

NPI: 1407644529
Provider Name (Legal Business Name): THE BODY OF CHRIST, YOUTH AND ADULT COUNSELING CENTER, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1458 E FORKS RD
BAY SHORE NY
11706-4337
US

IV. Provider business mailing address

PO BOX 524
BAY SHORE NY
11706-0652
US

V. Phone/Fax

Practice location:
  • Phone: 631-316-1564
  • Fax:
Mailing address:
  • Phone: 800-910-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: NATOUCHKA L VOIGT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 800-910-8748