Provider Demographics
NPI:1063798635
Name:SELFHELP LHCSA LONG ISLAND
Entity type:Organization
Organization Name:SELFHELP LHCSA LONG ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-971-7707
Mailing Address - Street 1:520 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 CLINTON ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4281
Practice Address - Country:US
Practice Address - Phone:516-505-2571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELFHELP COMMUNITY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0308L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00974438Medicaid