MEDICARE: ADOL PARNT INWOOD HS TS

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	:	1205996204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADOL PARNT INWOOD HS TS

Provider Business Mailing Address
First Line	:	369 E 148TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4041
Country	:	US
Telephone Number	:	718-742-8100
Fax Number	:	718-742-8099

Provider Business Practice Location Address
First Line	:	369 E 148TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4041
Country	:	US
Telephone Number	:	718-742-8100
Fax Number	:	718-742-8099

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LINDA LAUSELL BRYANT
Credential	:
Telephone Number	:	212-861-4400

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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