MEDICARE: PROJECT HOSPITALITY, 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	251S00000X	Community/Behavioral Health Agency	8215004A	NY
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	8215004A	NY
3	261QM0850X	Adult Mental Health Clinic/Center	8215004A	NY
4	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	:	1598882284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT HOSPITALITY, INC.

Provider Business Mailing Address
First Line	:	100 PARK AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1440
Country	:	US
Telephone Number	:	718-448-1544
Fax Number	:	718-720-5476

Provider Business Practice Location Address
First Line	:	150C RICHMOND TER
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-1901
Country	:	US
Telephone Number	:	718-420-1475
Fax Number	:	718-420-1487

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TERRY TROIA
Credential	:	M.A., D.D.
Telephone Number	:	718-448-1544

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	06/16/2015

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Directions to “PROJECT HOSPITALITY, INC. ” Practice Location

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