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NPI Code Detail

MEDICARE: THE REDEMPTION CENTER, INC.

MEDICARE: THE REDEMPTION CENTER, 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
1101Y00000XCounselorNY
2101YA0400XAddiction (Substance Use Disorder) CounselorNY
3101YM0800XMental Health CounselorNY
4101YP1600XPastoral CounselorNY
5104100000XSocial WorkerNY
61041C0700XClinical Social WorkerNY
7163W00000XRegistered NurseNY
8171000000XMilitary Health Care ProviderNY
9172V00000XCommunity Health WorkerNY
10251B00000XCase Management AgencyNY
11251V00000XVoluntary or Charitable Agency246212NY

General Provider Information

NPI Number : 1699181487
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE REDEMPTION CENTER, INC.
Provider Business Mailing Address
First Line : 1186 HERKIMER ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11233-3149
Country : US
Telephone Number : 718-922-1627
Fax Number : 347-221-0652
Provider Business Practice Location Address
First Line : 1186 HERKIMER ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11233-3149
Country : US
Telephone Number : 718-922-1627
Fax Number : 347-221-0652
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. MARK GRAHAM
Credential : MPS
Telephone Number : 718-922-1627
Provider Enumeration Date : 07/01/2014
Last Update Date : 07/01/2014

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