Provider Demographics
NPI:1750053948
Name:SRH CHN LEAD HEALTH HOME LLC
Entity Type:Organization
Organization Name:SRH CHN LEAD HEALTH HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-681-8700
Mailing Address - Street 1:1200 BROWN STREET
Mailing Address - Street 2:ATTN: HEALTH HOME
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 BROWN STREET
Practice Address - Street 2:ATTN: HEALTH HOME
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2913
Practice Address - Country:US
Practice Address - Phone:718-681-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management