Provider Demographics
NPI:1558586883
Name:BUSHWICK STUYVESANT HEIGHTS HOME ATTENDANTS, INC.
Entity Type:Organization
Organization Name:BUSHWICK STUYVESANT HEIGHTS HOME ATTENDANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-453-8400
Mailing Address - Street 1:992 GATES AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3602
Mailing Address - Country:US
Mailing Address - Phone:718-453-8400
Mailing Address - Fax:718-453-9391
Practice Address - Street 1:992 GATES AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3602
Practice Address - Country:US
Practice Address - Phone:718-453-8400
Practice Address - Fax:718-453-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0565L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00926527Medicaid