Provider Demographics
NPI:1871246769
Name:IMMIGRANT COMMUNITY DEVELOPMENT CENTER INC
Entity Type:Organization
Organization Name:IMMIGRANT COMMUNITY DEVELOPMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDILLAHI
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-459-8335
Mailing Address - Street 1:191 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1571
Mailing Address - Country:US
Mailing Address - Phone:413-291-9020
Mailing Address - Fax:
Practice Address - Street 1:191 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1571
Practice Address - Country:US
Practice Address - Phone:413-291-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)