Provider Demographics
NPI:1750934436
Name:HOUSING WORKS HEALTH SERVICES III, INC.
Entity type:Organization
Organization Name:HOUSING WORKS HEALTH SERVICES III, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-907-6236
Mailing Address - Street 1:57 WILLOUGHBY ST
Mailing Address - Street 2:2ND FL, CREDENTILALING DEPARTMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2640 PITKIN AVE
Practice Address - Street 2:OASAS DEPARTMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2629
Practice Address - Country:US
Practice Address - Phone:718-827-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSING WORKS HEALTH SERVICES III, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01826104Medicaid