Provider Demographics
NPI:1508279902
Name:REALIZATION CENTER
Entity Type:Organization
Organization Name:REALIZATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CILNICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:7183-426-7000
Mailing Address - Street 1:175 REMSEN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4333
Mailing Address - Country:US
Mailing Address - Phone:718-342-6700
Mailing Address - Fax:
Practice Address - Street 1:175 REMSEN ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4333
Practice Address - Country:US
Practice Address - Phone:718-342-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management