Provider Demographics
NPI:1942478003
Name:URBAN SUNS COMMUNITY DEVELOPMENT
Entity Type:Organization
Organization Name:URBAN SUNS COMMUNITY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:219-902-5226
Mailing Address - Street 1:1954 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407-2822
Mailing Address - Country:US
Mailing Address - Phone:219-902-5226
Mailing Address - Fax:
Practice Address - Street 1:1954 OHIO ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-2822
Practice Address - Country:US
Practice Address - Phone:219-902-5226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management