Provider Demographics
NPI:1790926939
Name:NORTH HUDSON COMMUNITY ACTION CORP. HEALTH CENTER
Entity Type:Organization
Organization Name:NORTH HUDSON COMMUNITY ACTION CORP. HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR: ADDICTION
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:LISK
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:201-866-9320
Mailing Address - Street 1:5301 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2622
Mailing Address - Country:US
Mailing Address - Phone:201-866-9320
Mailing Address - Fax:201-330-3825
Practice Address - Street 1:5301 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2622
Practice Address - Country:US
Practice Address - Phone:201-866-9320
Practice Address - Fax:201-330-3825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NHCAC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00064000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty