Provider Demographics
NPI:1972883528
Name:FORDHAM TREMONT COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:FORDHAM TREMONT COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS/PROJECT MANA
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHR
Authorized Official - Phone:718-583-6610
Mailing Address - Street 1:1102 LONGFELLOW AVE APT 4K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2667
Mailing Address - Country:US
Mailing Address - Phone:646-726-5970
Mailing Address - Fax:
Practice Address - Street 1:260 E 188TH STREET
Practice Address - Street 2:FORDHAM TREMONT SOUTH COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5302
Practice Address - Country:US
Practice Address - Phone:718-402-6380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST BARNABAS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083286-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital