Provider Demographics
NPI:1104711084
Name:FOUR DEANS COMMUNITY OUTREACH FOUNDATION INC.
Entity type:Organization
Organization Name:FOUR DEANS COMMUNITY OUTREACH FOUNDATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ODETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-293-9601
Mailing Address - Street 1:15 W 118TH ST STE UG4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1984
Mailing Address - Country:US
Mailing Address - Phone:929-735-6915
Mailing Address - Fax:
Practice Address - Street 1:15 W 118TH ST STE UG4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1984
Practice Address - Country:US
Practice Address - Phone:929-735-6915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)