Provider Demographics
NPI:1780832956
Name:JCB OF GLEN COVE
Entity Type:Organization
Organization Name:JCB OF GLEN COVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-676-6833
Mailing Address - Street 1:12 SYCAMORE ROAD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-676-6833
Mailing Address - Fax:516-676-6833
Practice Address - Street 1:12 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1725
Practice Address - Country:US
Practice Address - Phone:516-676-6833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY52100251B00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management