Healthcare Provider Details

I. General information

NPI: 1306058219
Provider Name (Legal Business Name): URBAN RESOURCE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4149 BENHAM STREET
ELMHURST NY
11373
US

IV. Provider business mailing address

22 CHAPEL STREET
BROOKLYN NY
11201
US

V. Phone/Fax

Practice location:
  • Phone: 718-899-8622
  • Fax:
Mailing address:
  • Phone: 718-260-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number7712441
License Number StateNY

VIII. Authorized Official

Name: EDDIE LIGHTSEY
Title or Position: SENIOR VICE PRESIDENT
Credential: MBA
Phone: 718-260-2901