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NPI Code Detail

MEDICARE: NINE LIVES SANCTUARY

MEDICARE: NINE LIVES SANCTUARY
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1154886372
Entity Type Code : Organization
Provider Name (Legal Business Name) : NINE LIVES SANCTUARY
Provider Business Mailing Address
First Line : PO BOX 1069
Second Line :
City : BRONX
State : NY
Zip : 10462-0575
Country : US
Telephone Number : 347-739-8770
Fax Number :
Provider Business Practice Location Address
First Line : 1136 NEILL AVE
Second Line :
City : BRONX
State : NY
Zip : 10461-1328
Country : US
Telephone Number : 347-739-8770
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. DONALD EUGENE COFIELD
Credential : LMSW
Telephone Number : 347-739-8770
Provider Enumeration Date : 02/01/2019
Last Update Date : 02/01/2019

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Directions to “NINE LIVES SANCTUARY ” Practice Location

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