Provider Demographics
NPI:1437278827
Name:SOCIAL CONCERN VENDOR AGENCY, INC.
Entity Type:Organization
Organization Name:SOCIAL CONCERN VENDOR AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GAIRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-978-3700
Mailing Address - Street 1:18445 147TH AVE
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3746
Mailing Address - Country:US
Mailing Address - Phone:718-978-3700
Mailing Address - Fax:718-978-2759
Practice Address - Street 1:18445 147TH AVE
Practice Address - Street 2:SUITE 100B
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3746
Practice Address - Country:US
Practice Address - Phone:718-978-3700
Practice Address - Fax:718-978-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00925195-03Medicaid