Provider Demographics
NPI:1912461773
Name:CARE FOR THE HOMELESS
Entity Type:Organization
Organization Name:CARE FOR THE HOMELESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAILJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATTA
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:212-366-4459
Mailing Address - Street 1:30 E 33RD ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5337
Mailing Address - Country:US
Mailing Address - Phone:212-366-4459
Mailing Address - Fax:212-366-4585
Practice Address - Street 1:427 W 52ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5605
Practice Address - Country:US
Practice Address - Phone:212-366-4459
Practice Address - Fax:212-366-4585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE FOR THE HOMELESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-25
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03064422Medicaid