1821252743 NPI number — COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION

Table of content: (NPI 1821252743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821252743 NPI number — COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821252743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
731 WHITE PLAINS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10473-2631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-589-8324
Provider Business Mailing Address Fax Number:
718-860-1838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 E BURNSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10453-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-539-0003
Provider Business Practice Location Address Fax Number:
718-569-9054
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ESPADA
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
718-589-2232

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  7000239R , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00665274 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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