Provider Demographics
NPI:1952513947
Name:JOSHUA HOUSE INC
Entity Type:Organization
Organization Name:JOSHUA HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-563-3994
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:SIDNEY CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13839
Mailing Address - Country:US
Mailing Address - Phone:607-563-3994
Mailing Address - Fax:607-563-9936
Practice Address - Street 1:10 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838
Practice Address - Country:US
Practice Address - Phone:607-563-3994
Practice Address - Fax:607-563-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02257261251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02257261Medicaid