Healthcare Provider Details

I. General information

NPI: 1063573152
Provider Name (Legal Business Name): VILLAGE CENTER FOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CHARLES ST 2ND FLOOR
NEW YORK NY
10014-2653
US

IV. Provider business mailing address

120 BROADWAY SUITE 2840
NEW YORK NY
10271-0009
US

V. Phone/Fax

Practice location:
  • Phone: 212-337-5600
  • Fax: 212-337-5839
Mailing address:
  • Phone: 212-337-5816
  • Fax: 212-337-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number7002335N
License Number StateNY

VIII. Authorized Official

Name: RACHEL AMALFITARO
Title or Position: CFO
Credential:
Phone: 212-337-5816