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General NPI Number Information
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NPI Number | 1063798635
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Entity Type | Organization
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Legal Business Name | SELFHELP LHCSA LONG ISLAND
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 50 CLINTON ST
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City | HEMPSTEAD
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State | NY
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Zip | 11550-4281
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Country | US
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Telephone | 516-505-2571
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Fax |
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Provider Business Mailing Address
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Address Line | 520 8TH AVE
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City | NEW YORK
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State | NY
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Zip | 10018-6507
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT, ADMINISTRATION
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Name | MR. RUSSELL LUSAK
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Credential |
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Telephone | 212-971-7707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0308L001
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License Number State | NY
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