Provider Demographics
NPI:1972916344
Name:UJIMA HOUSE
Entity Type:Organization
Organization Name:UJIMA HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HURWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-979-8800
Mailing Address - Street 1:2006 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1217
Mailing Address - Country:US
Mailing Address - Phone:212-979-8800
Mailing Address - Fax:212-979-8917
Practice Address - Street 1:1808 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6103
Practice Address - Country:US
Practice Address - Phone:646-632-3920
Practice Address - Fax:646-632-3939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALLADIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-03
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150511550324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility