Provider Demographics
NPI:1114950151
Name:HOUSING WORKS HEALTH SERVICES III, INC.
Entity Type:Organization
Organization Name:HOUSING WORKS HEALTH SERVICES III, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-408-6522
Mailing Address - Street 1:57 WILLOUGHBY ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5290
Mailing Address - Country:US
Mailing Address - Phone:347-473-7400
Mailing Address - Fax:347-473-7464
Practice Address - Street 1:2640 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2629
Practice Address - Country:US
Practice Address - Phone:718-827-8700
Practice Address - Fax:718-827-5557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSING WORKS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01826104Medicaid