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General NPI Number Information
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NPI Number | 1619354552
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Entity Type | Organization
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Legal Business Name | SERVICES FOR THE UNDERSERVED, INC.
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 101-38 92ND STREET
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City | OZONE PARK
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State | NY
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Zip | 11416-2205
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Country | US
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Telephone | 917-408-1642
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Fax | 855-370-9384
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Provider Business Mailing Address
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Address Line | 305 7TH AVE 10TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10001-6008
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Country | US
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Telephone | 917-408-1642
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Fax | 855-370-9384
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Authorized Official
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Title or Position | DIRECTOR - MEDICAID BILLING
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Name | LIN YANG
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Credential | MBA
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Telephone | 917-408-1642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 7559303
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License Number State | NY
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