Provider Demographics
NPI:1255410437
Name:CENTRO SOCIAL LA ESPERANZA, INC.
Entity type:Organization
Organization Name:CENTRO SOCIAL LA ESPERANZA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-928-5810
Mailing Address - Street 1:2212 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3530
Mailing Address - Country:US
Mailing Address - Phone:212-928-5810
Mailing Address - Fax:212-740-2053
Practice Address - Street 1:2212 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3530
Practice Address - Country:US
Practice Address - Phone:212-928-5810
Practice Address - Fax:212-740-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6245300251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357951Medicaid