MEDICARE: EAST HARLEM COUNCIL FOR COMMUNITY IMPROVEMENT

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	385H00000X	Respite Care	82220813	NY

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	:	1700915493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST HARLEM COUNCIL FOR COMMUNITY IMPROVEMENT

Provider Business Mailing Address
First Line	:	413 E 120TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-3602
Country	:	US
Telephone Number	:	212-410-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 E 120TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-3602
Country	:	US
Telephone Number	:	212-410-7707
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. TOMAS DEL RIO
Credential	:
Telephone Number	:	347-649-3083

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	03/02/2009

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