Provider Demographics
NPI:1699840967
Name:SELFHELP COMMUNITY SERVICES, INC
Entity Type:Organization
Organization Name:SELFHELP COMMUNITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-971-7707
Mailing Address - Street 1:520 EIGHTH AVENUE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6553
Mailing Address - Country:US
Mailing Address - Phone:212-971-7000
Mailing Address - Fax:212-629-9482
Practice Address - Street 1:520 EIGHTH AVENUE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6553
Practice Address - Country:US
Practice Address - Phone:212-971-7000
Practice Address - Fax:212-629-9482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0308L003251E00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009474438Medicaid