Healthcare Provider Details

I. General information

NPI: 1598882284
Provider Name (Legal Business Name): PROJECT HOSPITALITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150C RICHMOND TER
STATEN ISLAND NY
10301-1901
US

IV. Provider business mailing address

100 PARK AVE
STATEN ISLAND NY
10302-1440
US

V. Phone/Fax

Practice location:
  • Phone: 718-420-1475
  • Fax: 718-420-1487
Mailing address:
  • Phone: 718-448-1544
  • Fax: 718-720-5476

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 Number8215004A
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number8215004A
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number8215004A
License Number StateNY

VIII. Authorized Official

Name: TERRY TROIA
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A., D.D.
Phone: 718-448-1544