Provider Demographics
NPI:1821556929
Name:HAITIAN AMERICANS UNITED FOR PROGRESS INC.
Entity Type:Organization
Organization Name:HAITIAN AMERICANS UNITED FOR PROGRESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-527-3776
Mailing Address - Street 1:19717 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2126
Mailing Address - Country:US
Mailing Address - Phone:718-527-3776
Mailing Address - Fax:718-276-5481
Practice Address - Street 1:19717 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2126
Practice Address - Country:US
Practice Address - Phone:718-527-3776
Practice Address - Fax:718-276-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21130Medicaid