MEDICARE: PROGRAM DEVELOPMENT SERVICES, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1194802603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRAM DEVELOPMENT SERVICES, INC

Provider Business Mailing Address
First Line	:	6916 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1810
Country	:	US
Telephone Number	:	718-256-2212
Fax Number	:	718-256-7433

Provider Business Practice Location Address
First Line	:	860 E 38TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3538
Country	:	US
Telephone Number	:	718-434-3423
Fax Number	:	718-421-5889

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PATRICIA HARRISON
Credential	:
Telephone Number	:	718-256-2212

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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