Provider Demographics
NPI:1245528231
Name:SELFHELP ALZHEIMERS RESOURCE PROGRAM
Entity type:Organization
Organization Name:SELFHELP ALZHEIMERS RESOURCE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-971-7707
Mailing Address - Street 1:520 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6507
Mailing Address - Country:US
Mailing Address - Phone:212-971-7726
Mailing Address - Fax:
Practice Address - Street 1:208-11 26TH AVENUE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360
Practice Address - Country:US
Practice Address - Phone:212-971-7726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELFHELP COMMUNITY SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030L003251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03191848Medicaid