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General NPI Number Information
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NPI Number | 1063872935
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Entity Type | Organization
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Legal Business Name | TEMICHA SUPPORT LINE
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 400 RELLA BLVD
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City | SUFFERN
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State | NY
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Zip | 10901-4241
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Country | US
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Telephone | 845-213-5838
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Fax | 845-369-9472
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Provider Business Mailing Address
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Address Line | 400 RELLA BLVD P O BOX 44
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City | SUFFERN
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State | NY
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Zip | 10901-4241
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Country | US
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Telephone | 845-213-5838
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Fax | 845-369-9472
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Authorized Official
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Title or Position | CEO
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Name | PEARL KAUFMAN
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Credential |
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Telephone | 845-213-5838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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