Provider Demographics
NPI:1811074362
Name:TREMONT COMMUNITY COUNCIL HOME ATTENDANT PROGRAM, INC
Entity type:Organization
Organization Name:TREMONT COMMUNITY COUNCIL HOME ATTENDANT PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:O'DELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-239-0608
Mailing Address - Street 1:1200 WATERS PL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-239-0608
Mailing Address - Fax:718-239-1323
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE 106
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-239-0608
Practice Address - Fax:718-239-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9626L001251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00926307Medicaid