Healthcare Provider Details

I. General information

NPI: 1326493982
Provider Name (Legal Business Name): LA CASA DE SALUD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 E 151ST ST
BRONX NY
10455
US

IV. Provider business mailing address

311 E 175TH ST
BRONX NY
10457-5859
US

V. Phone/Fax

Practice location:
  • Phone: 347-352-2484
  • Fax: 917-473-6970
Mailing address:
  • Phone: 718-960-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number7000271R
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: VICKY GATELL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 718-960-7629