=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417746918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOWER WEST SIDE HOUSEHOLD SERVICES CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 DOLSON AVE STE 206A
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-6570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-722-2467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 DOLSON AVE
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-6569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-307-7107
-----------------------------------------------------
Fax | 646-878-0356
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MS. KELLY DENG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-307-7107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------