Provider Demographics
NPI:1811233786
Name:CARE FOR THE HOMELESS
Entity Type:Organization
Organization Name:CARE FOR THE HOMELESS
Other - Org Name:CARE FOR THE HOMELESS ST JOHN'S BREAD AND LIFE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-366-4459
Mailing Address - Street 1:30 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5337
Mailing Address - Country:US
Mailing Address - Phone:212-366-4459
Mailing Address - Fax:212-366-1773
Practice Address - Street 1:795 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-2903
Practice Address - Country:US
Practice Address - Phone:347-294-2412
Practice Address - Fax:212-366-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70000279R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)