Provider Demographics
NPI:1063906212
Name:SAMISSETT HUMANE SERVICES
Entity type:Organization
Organization Name:SAMISSETT HUMANE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FUNMILAYO
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:OYIBO-EBIJE
Authorized Official - Suffix:
Authorized Official - Credentials:EO
Authorized Official - Phone:516-503-8790
Mailing Address - Street 1:15 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1829
Mailing Address - Country:US
Mailing Address - Phone:516-806-8879
Mailing Address - Fax:
Practice Address - Street 1:179B COURT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3824
Practice Address - Country:US
Practice Address - Phone:347-727-8452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251V00000XAgenciesVoluntary or Charitable