Provider Demographics
NPI:1417746918
Name:LOWER WEST SIDE HOUSEHOLD SERVICES CORPORATION
Entity type:Organization
Organization Name:LOWER WEST SIDE HOUSEHOLD SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-307-7107
Mailing Address - Street 1:225 DOLSON AVE STE 206A
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6570
Mailing Address - Country:US
Mailing Address - Phone:212-307-7107
Mailing Address - Fax:646-878-0356
Practice Address - Street 1:225 DOLSON AVE STE 206A
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6570
Practice Address - Country:US
Practice Address - Phone:914-722-2467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0217L002OtherLICENSE