Provider Demographics
NPI:1568853554
Name:IYAHO SOCIAL SERVICES INC
Entity Type:Organization
Organization Name:IYAHO SOCIAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EROMOSELE
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:516-280-5930
Mailing Address - Street 1:71 NORTH FRANKLIN STREET #-211
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550
Mailing Address - Country:US
Mailing Address - Phone:516-280-5930
Mailing Address - Fax:
Practice Address - Street 1:71 N FRANKLIN ST # 211
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3048
Practice Address - Country:US
Practice Address - Phone:516-280-5930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
251C00000X, 251G00000X, 261QA0600X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03132661Medicaid
NY03122158Medicaid
NY02939559Medicaid