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General NPI Number Information
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NPI Number | 1326493982
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Entity Type | Organization
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Legal Business Name | LA CASA DE SALUD, INC
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 754 E 151ST ST
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City | BRONX
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State | NY
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Zip | 10455
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Country | US
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Telephone | 347-352-2484
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Fax | 917-473-6970
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Provider Business Mailing Address
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Address Line | 311 E 175TH ST
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City | BRONX
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State | NY
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Zip | 10457-5859
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Country | US
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Telephone | 718-960-7568
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | VICKY GATELL
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Credential |
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Telephone | 718-960-7629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 7000271R
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License Number State | NY
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