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Organization
SOURCE HOLDINGS LLC
Active
Organization
SOURCE HOLDINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GINA DECESARE MS,OTR/L (OWNER/SOLE PROPRIETOR)
(914) 263-1713
Entity
Organization
Contact information
Practice address
466 MAIN ST, NEW ROCHELLE, NY 10801-6431
(718) 769-2698
Mailing address
13 BRYANT CRES APT 1L, WHITE PLAINS, NY 10605-2711
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NULL
Other
Enumeration date
09/06/2019
Last updated
09/06/2019
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