Healthcare Provider Details

I. General information

NPI: 1164049078
Provider Name (Legal Business Name): CHRISTOPHER ROSE COMMUNITY EMPOWERMENT CAMPAIGN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 BROOKLYN AVE
BROOKLYN NY
11210
US

IV. Provider business mailing address

772 VERMONT ST
BROOKLYN NY
11207-7009
US

V. Phone/Fax

Practice location:
  • Phone: 718-282-7232
  • Fax: 718-282-7231
Mailing address:
  • Phone: 718-272-2363
  • Fax: 718-272-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: SHARON ANN COOMBS-ROSE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 718-272-2363