MEDICARE: PROTESTANT BOARD OF GUARDIANS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063682623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROTESTANT BOARD OF GUARDIANS INC

Provider Business Mailing Address
First Line	:	1368 FULTON ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2635
Country	:	US
Telephone Number	:	718-636-8103
Fax Number	:	718-636-8616

Provider Business Practice Location Address
First Line	:	1368 FULTON ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2635
Country	:	US
Telephone Number	:	718-636-8103
Fax Number	:	718-636-8616

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ROBERT B GREENE
Credential	:	LCSWR
Telephone Number	:	718-636-8103

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/10/2008

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Directions to “PROTESTANT BOARD OF GUARDIANS INC ” Practice Location

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