Provider Demographics
NPI:1063872935
Name:TEMICHA SUPPORT LINE
Entity type:Organization
Organization Name:TEMICHA SUPPORT LINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEARL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-213-5838
Mailing Address - Street 1:400 RELLA BLVD
Mailing Address - Street 2:P O BOX 44
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4241
Mailing Address - Country:US
Mailing Address - Phone:845-213-5838
Mailing Address - Fax:845-369-9472
Practice Address - Street 1:400 RELLA BLVD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4241
Practice Address - Country:US
Practice Address - Phone:845-213-5838
Practice Address - Fax:845-369-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty