Provider Demographics
NPI:1609336841
Name:SUPPORTIVE SERVICES FOR CHILDREN, INC
Entity Type:Organization
Organization Name:SUPPORTIVE SERVICES FOR CHILDREN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT &CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODIGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-238-1435
Mailing Address - Street 1:14813 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3330
Mailing Address - Country:US
Mailing Address - Phone:347-238-1435
Mailing Address - Fax:347-238-1435
Practice Address - Street 1:14813 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3330
Practice Address - Country:US
Practice Address - Phone:347-238-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY213624839Medicaid