=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669916649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEIGHBORHOOD COALITION FOR SHELTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2016
-----------------------------------------------------
Last Update Date | 12/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 921 MADISON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-677-0724
-----------------------------------------------------
Fax | 212-879-5328
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 921 MADISON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-677-0724
-----------------------------------------------------
Fax | 212-879-5328
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | MRS. EMILY JOHNSON
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 917-677-0724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 180811623
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------