Healthcare Provider Details

I. General information

NPI: 1528137767
Provider Name (Legal Business Name): PSC COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 21ST ST 2ND FLOOR
LONG ISLAND CITY NY
11101-5357
US

IV. Provider business mailing address

5102 21ST ST 2ND FLOOR
LONG ISLAND CITY NY
11101-5357
US

V. Phone/Fax

Practice location:
  • Phone: 718-389-7060
  • Fax: 718-389-6781
Mailing address:
  • Phone: 718-389-7060
  • Fax: 718-389-6781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0542L001
License Number StateNY

VIII. Authorized Official

Name: MR. CHRISTOPHER H OLECHOWSKI
Title or Position: DIRECTOR
Credential:
Phone: 718-398-7068