Provider Demographics
NPI:1477095008
Name:TSIFS TRI-STATE INTEGRATED FAMILY SERVICES INC
Entity Type:Organization
Organization Name:TSIFS TRI-STATE INTEGRATED FAMILY SERVICES INC
Other - Org Name:TSIFS TRI-STATE INTEGRATED FAMILY SERVICES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VERDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-621-1403
Mailing Address - Street 1:3042 WESTCHESTER AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4533
Mailing Address - Country:US
Mailing Address - Phone:347-621-1403
Mailing Address - Fax:347-621-1405
Practice Address - Street 1:3042 WESTCHESTER AVENUE
Practice Address - Street 2:STE 4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:347-621-1403
Practice Address - Fax:347-621-1405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TSIFS TRI-STATE INTEGRATED FAMILY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health