MEDICARE: BLACK CHERUBS 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	251V00000X	Voluntary or Charitable Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1679252142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK CHERUBS INC.

Provider Business Mailing Address
First Line	:	226 E 37TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5209 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3578
Country	:	US
Telephone Number	:	347-674-7311
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NKOSI APPLEWHITE
Credential	:
Telephone Number	:	917-497-7919

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	07/12/2023

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Directions to “BLACK CHERUBS INC. ” Practice Location

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