MEDICARE: INTERNATIONAL CENTER FOE THE DISABLED

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	320800000X	Mental Illness Community Based Residential Treatment Facility	007068-1	NY

General Provider Information

NPI Number	:	1164758454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL CENTER FOE THE DISABLED

Provider Business Mailing Address
First Line	:	270 JAY ST APT 4A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1938
Country	:	US
Telephone Number	:	718-855-8971
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 JAY ST # 51
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1949
Country	:	US
Telephone Number	:	347-645-4866
Fax Number	:

Authorized Official
Title or Position	:	HR MANAGER
Name	:	DEBRAH STRAW
Credential	:
Telephone Number	:	12125856115

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/22/2009

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Directions to “INTERNATIONAL CENTER FOE THE DISABLED ” Practice Location

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