Healthcare Provider Details

I. General information

NPI: 1699840967
Provider Name (Legal Business Name): SELFHELP COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 EIGHTH AVENUE 5TH FLOOR
NEW YORK NY
10018-6553
US

IV. Provider business mailing address

520 EIGHTH AVENUE 5TH FLOOR
NEW YORK NY
10018-6553
US

V. Phone/Fax

Practice location:
  • Phone: 212-971-7000
  • Fax: 212-629-9482
Mailing address:
  • Phone: 212-971-7000
  • Fax: 212-629-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0308L003
License Number StateNY

VIII. Authorized Official

Name: MR. RUSSELL LUSAK
Title or Position: VICE PRESIDENT, ADMINISTRATION
Credential:
Phone: 212-971-7707