Provider Demographics
NPI:1154886372
Name:NINE LIVES SANCTUARY
Entity type:Organization
Organization Name:NINE LIVES SANCTUARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:COFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:347-739-8770
Mailing Address - Street 1:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-0575
Mailing Address - Country:US
Mailing Address - Phone:347-739-8770
Mailing Address - Fax:
Practice Address - Street 1:1136 NEILL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1328
Practice Address - Country:US
Practice Address - Phone:347-739-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty