Provider Demographics
NPI:1679556450
Name:VILLAGE CENTER FOR CARE
Entity Type:Organization
Organization Name:VILLAGE CENTER FOR CARE
Other - Org Name:20TH STREET AIDS DAY TREATMENT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-337-5710
Mailing Address - Street 1:120 BROADWAY
Mailing Address - Street 2:SUITE 2840
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10271-0009
Mailing Address - Country:US
Mailing Address - Phone:212-337-5710
Mailing Address - Fax:212-337-5839
Practice Address - Street 1:121 W 20TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3641
Practice Address - Country:US
Practice Address - Phone:212-337-9221
Practice Address - Fax:212-633-6587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE CENTER FOR CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-25
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002335N261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01186305Medicaid