Provider Demographics
NPI:1083771232
Name:INWOOD COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:INWOOD COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CORLISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-942-0043
Mailing Address - Street 1:651 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5003
Mailing Address - Country:US
Mailing Address - Phone:212-942-0043
Mailing Address - Fax:212-567-9476
Practice Address - Street 1:651 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5003
Practice Address - Country:US
Practice Address - Phone:212-942-0043
Practice Address - Fax:212-567-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7876100A251S00000X
NY070510836251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01060402Medicaid