Provider Demographics
NPI:1568018505
Name:EBONY EYES COMMUNITY SERVICES CENTER INC.
Entity Type:Organization
Organization Name:EBONY EYES COMMUNITY SERVICES CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:ALTINA
Authorized Official - Last Name:SANJURJO
Authorized Official - Suffix:I
Authorized Official - Credentials:CEO
Authorized Official - Phone:917-544-3151
Mailing Address - Street 1:1646 ANDREWS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7347
Mailing Address - Country:US
Mailing Address - Phone:917-544-3151
Mailing Address - Fax:
Practice Address - Street 1:1646 ANDREWS AVE APT 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7347
Practice Address - Country:US
Practice Address - Phone:917-544-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child