Healthcare Provider Details

I. General information

NPI: 1477684967
Provider Name (Legal Business Name): BOWERY RESIDENTS' COMMITTEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W 25TH ST 12TH FLOOR
NEW YORK NY
10001-7207
US

IV. Provider business mailing address

131 W 25TH ST 12TH FLOOR
NEW YORK NY
10001-7207
US

V. Phone/Fax

Practice location:
  • Phone: 212-803-5700
  • Fax: 212-533-1893
Mailing address:
  • Phone: 212-803-5700
  • Fax: 212-533-1893

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number150311840
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number151110622
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number131110622
License Number StateNY

VIII. Authorized Official

Name: MR. LAWRENCE ROSENBLATT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 212-803-5701