Provider Demographics
NPI:1972715928
Name:UNITED CEREBRAL PALSY
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIREILLE
Authorized Official - Middle Name:CARMITE
Authorized Official - Last Name:LATORTUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:1516-489-7925
Mailing Address - Street 1:631 JENNINGS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3707
Mailing Address - Country:US
Mailing Address - Phone:917-930-4278
Mailing Address - Fax:
Practice Address - Street 1:175 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1102
Practice Address - Country:US
Practice Address - Phone:718-436-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY450541-1251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services