Provider Demographics
NPI:1609293612
Name:CITISOCIAL NEW YORK, LLC
Entity Type:Organization
Organization Name:CITISOCIAL NEW YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SILVA
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:UMUKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-312-0561
Mailing Address - Street 1:154 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3739
Mailing Address - Country:US
Mailing Address - Phone:917-312-0561
Mailing Address - Fax:
Practice Address - Street 1:154 W 127TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3739
Practice Address - Country:US
Practice Address - Phone:917-312-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care