=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336839471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JH COMMUNITY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2023
-----------------------------------------------------
Last Update Date | 09/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 SHEEP PASTURE LANE
-----------------------------------------------------
City | SHELTER ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-321-5113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 228 PARK AVE S STE 36053
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-1502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-321-5113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROMANOS FESSAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-321-5113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WH0202X
-----------------------------------------------------
Taxonomy Name | Home Modifications Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------