Organization
SERVICES FOR THE UNDERSERVED
Active
Other names
Services for the Underserved Fountain ICF
Organization subpart
No
Provider details
NPI number
Authorized official
LIN YANG MBA (DIRECTOR - MEDICAID BILLING)
(917) 408-1642
Entity
Organization
Contact information
Practice address
888 FOUNTAIN AVE, SUITE 221-224, BROOKLYN, NY 11239-5907
(718) 642-6034
Mailing address
305 7TH AVE, 10TH FLOOR, NEW YORK, NY 10001-6008
(917) 408-1642
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
7559303
NY
Other
Enumeration date
03/24/2015
Last updated
03/24/2015
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