Provider Demographics
NPI:1295003838
Name:JEWISH BOARD OF FAMILY AND CHILDREN SERVICES
Entity Type:Organization
Organization Name:JEWISH BOARD OF FAMILY AND CHILDREN SERVICES
Other - Org Name:STATEN ISLAND CHILDREN'S COMMUNITY RESIDENCE
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-370-2975
Mailing Address - Street 1:19 VEDDER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1509
Mailing Address - Country:US
Mailing Address - Phone:718-370-2975
Mailing Address - Fax:718-494-7836
Practice Address - Street 1:19 VEDDER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1509
Practice Address - Country:US
Practice Address - Phone:718-370-2975
Practice Address - Fax:718-494-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-11
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3980341320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness