Organization
SERVICES FOR THE UNDERSERVED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LYNETTE BACCHUS (AR SPERVISOR)
(917) 408-1611
Entity
Organization
Contact information
Practice address
305 7TH AVE, NEW YORK, NY 10001-6008
(917) 408-1611
Mailing address
305 7TH AVE, NEW YORK, NY 10001-6008
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/03/2008
Last updated
04/03/2008
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