Provider Demographics
NPI:1083820583
Name:BAILEY HOUSE INC
Entity Type:Organization
Organization Name:BAILEY HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:718-408-6522
Mailing Address - Street 1:1751 PARK AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2831
Mailing Address - Country:US
Mailing Address - Phone:212-633-2500
Mailing Address - Fax:212-633-2932
Practice Address - Street 1:1751 PARK AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2831
Practice Address - Country:US
Practice Address - Phone:212-633-2500
Practice Address - Fax:212-633-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QF0400X
NY8124001A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02822911Medicaid