Healthcare Provider Details

I. General information

NPI: 1205048105
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: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15519 LINDEN BLVD
JAMAICA NY
11434-1017
US

IV. Provider business mailing address

75 BROAD ST SUITE 505
NEW YORK NY
10004-2415
US

V. Phone/Fax

Practice location:
  • Phone: 646-588-0030
  • Fax: 646-588-0033
Mailing address:
  • Phone: 646-588-0030
  • Fax: 646-588-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number7712440
License Number StateNY

VIII. Authorized Official

Name: DONOVAN MURRAY
Title or Position: SENIOR VICE PRESIDENT, FINANCE/CFO
Credential: CPA
Phone: 646-588-0040