Healthcare Provider Details

I. General information

NPI: 1790126456
Provider Name (Legal Business Name): M.C. PROVISIONS FOR HUMAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 34TH AVE
CORONA NY
11368-1332
US

IV. Provider business mailing address

10920 34TH AVE
CORONA NY
11368-1332
US

V. Phone/Fax

Practice location:
  • Phone: 516-445-4755
  • Fax: 718-481-9396
Mailing address:
  • Phone: 516-445-4755
  • Fax: 718-481-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARESSE WHITE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 516-445-4755