Provider Demographics
NPI: | 1164878468 |
---|---|
Name: | PIBLY RESIDENTIAL PROGRAMS, INC. |
Entity Type: | Organization |
Organization Name: | PIBLY RESIDENTIAL PROGRAMS, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ASSOCIATE EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | MADELIN |
Authorized Official - Middle Name: | ENID |
Authorized Official - Last Name: | WEISS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMSW |
Authorized Official - Phone: | 718-863-4100 |
Mailing Address - Street 1: | 2415 WESTCHESTER AVENUE |
Mailing Address - Street 2: | |
Mailing Address - City: | BRONX |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10461 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-863-4100 |
Mailing Address - Fax: | 718-863-5165 |
Practice Address - Street 1: | 2415 WESTCHESTER AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | BRONX |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10461 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-863-4100 |
Practice Address - Fax: | 718-863-5165 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-05-05 |
Last Update Date: | 2016-05-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 035393 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |