Provider Demographics
NPI:1740334879
Name:CATH CHAR NGHBHD SVS ADESSA ICF
Entity type:Organization
Organization Name:CATH CHAR NGHBHD SVS ADESSA ICF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRADO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-722-6123
Mailing Address - Street 1:191 JORALEMON ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4306
Mailing Address - Country:US
Mailing Address - Phone:718-722-6038
Mailing Address - Fax:
Practice Address - Street 1:10138 92ND ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2205
Practice Address - Country:US
Practice Address - Phone:718-848-1940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES NEIGHBORHOOD SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01128629Medicaid