Provider Demographics
NPI:1982721197
Name:EDWIN GOULD SERVICES FOR CHILDREN AND FAMILIESQ
Entity Type:Organization
Organization Name:EDWIN GOULD SERVICES FOR CHILDREN AND FAMILIESQ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEATHERSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:212-437-3560
Mailing Address - Street 1:40 RECTOR ST
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1705
Mailing Address - Country:US
Mailing Address - Phone:212-437-3500
Mailing Address - Fax:212-437-3598
Practice Address - Street 1:1128 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5002
Practice Address - Country:US
Practice Address - Phone:718-992-1310
Practice Address - Fax:718-537-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6009440315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357153Medicaid