Healthcare Provider Details

I. General information

NPI: 1336642040
Provider Name (Legal Business Name): REFUGEE & IMMIGRANT SELF-EMPOWERMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 BURT ST
SYRACUSE NY
13202-3911
US

IV. Provider business mailing address

302 BURT ST
SYRACUSE NY
13202-3911
US

V. Phone/Fax

Practice location:
  • Phone: 315-214-4480
  • Fax:
Mailing address:
  • Phone: 315-214-4480
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HAJI ADAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 315-214-4480