Provider Demographics
NPI:1891232179
Name:EVELYN DOUGLIN CENTER SPIN
Entity Type:Organization
Organization Name:EVELYN DOUGLIN CENTER SPIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AED
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-965-1998
Mailing Address - Street 1:241 37TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2417
Mailing Address - Country:US
Mailing Address - Phone:718-965-1998
Mailing Address - Fax:
Practice Address - Street 1:470 CHESTER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5505
Practice Address - Country:US
Practice Address - Phone:718-965-1998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90580471Medicaid
NY90580472Medicaid