Healthcare Provider Details

I. General information

NPI: 1578115226
Provider Name (Legal Business Name): DOMINICAN WOMEN'S DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 09/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 WEST 179TH STREET GROUND FLOOR
NEW YORK NY
10033
US

IV. Provider business mailing address

519 W 189TH ST
NEW YORK NY
10040-4647
US

V. Phone/Fax

Practice location:
  • Phone: 212-740-4335
  • Fax: 212-994-6065
Mailing address:
  • Phone: 212-994-6060
  • Fax: 212-994-6065

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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSITA MERCEDES ROMERO
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 212-994-6060