MEDICARE: CARE FOR THE HOMELESS

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1568030021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE FOR THE HOMELESS

Provider Business Mailing Address
First Line	:	30 E 33RD ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-5337
Country	:	US
Telephone Number	:	212-366-4459
Fax Number	:	347-823-1561

Provider Business Practice Location Address
First Line	:	150 RICHMOND TER
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-1901
Country	:	US
Telephone Number	:	212-366-4459
Fax Number	:	347-823-1561

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	SHAILJA BHATTA
Credential	:
Telephone Number	:	212-366-4459

Provider Enumeration Date	:	06/11/2021
Last Update Date	:	06/11/2021

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Directions to “CARE FOR THE HOMELESS ” Practice Location

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