Provider Demographics
NPI:1528137767
Name:PSC COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:PSC COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:H
Authorized Official - Last Name:OLECHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-398-7068
Mailing Address - Street 1:5102 21ST ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5357
Mailing Address - Country:US
Mailing Address - Phone:718-389-7060
Mailing Address - Fax:718-389-6781
Practice Address - Street 1:5102 21ST ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5357
Practice Address - Country:US
Practice Address - Phone:718-389-7060
Practice Address - Fax:718-389-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0542L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00926090Medicaid
NY=========OtherFEDERAL ID NO.