Basic Information
| Provider Information | |||||||||
| NPI: | 1164723714 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN OF PROMISE, NYC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54 MACDONOUGH ST. | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112162304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184839290 | ||||||||
| FaxNumber: | 7184142715 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 MACDONOUGH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112162304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184829290 | ||||||||
| FaxNumber: | 7184839287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2010 | ||||||||
| LastUpdateDate: | 09/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | CONTENT | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | LISA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7184839290 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 09/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | NY | N | Agencies | Case Management | 251S00000X | N | Agencies | Community/Behavioral Health | 347B00000X | NY | N | Transportation Services | Bus | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 03505424 | 05 | NY | MEDICAID |