Provider Demographics
NPI:1932562840
Name:LOWER WEST SIDE HOUSEHOLD SERVICE CORPORATION
Entity Type:Organization
Organization Name:LOWER WEST SIDE HOUSEHOLD SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-307-7107
Mailing Address - Street 1:16 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0113
Mailing Address - Country:US
Mailing Address - Phone:212-307-7107
Mailing Address - Fax:
Practice Address - Street 1:460 WILLIS AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4013
Practice Address - Country:US
Practice Address - Phone:212-307-7107
Practice Address - Fax:646-878-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0217L001251E00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01669685Medicaid
NY01552221Medicaid