Provider Demographics
NPI:1043413750
Name:SOCIAL CONCERN COMMUNITY DEVELOPMENT
Entity Type:Organization
Organization Name:SOCIAL CONCERN COMMUNITY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-978-7775
Mailing Address - Street 1:22618 MERRICK BLVD
Mailing Address - Street 2:LAURELTON
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2101
Mailing Address - Country:US
Mailing Address - Phone:718-978-7775
Mailing Address - Fax:718-276-3766
Practice Address - Street 1:22618 MERRICK BLVD
Practice Address - Street 2:LAURELTON
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-2101
Practice Address - Country:US
Practice Address - Phone:718-978-7775
Practice Address - Fax:718-276-3766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9622L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health