Provider Demographics
NPI:1962177311
Name:NICHOLAS AND MATTIE CENTER FOR THE HOMELESS
Entity type:Organization
Organization Name:NICHOLAS AND MATTIE CENTER FOR THE HOMELESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TENESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKS-OKWARA
Authorized Official - Suffix:
Authorized Official - Credentials:HHP
Authorized Official - Phone:860-840-8774
Mailing Address - Street 1:12 MADISON ST # 1L
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2632
Mailing Address - Country:US
Mailing Address - Phone:860-840-8774
Mailing Address - Fax:
Practice Address - Street 1:12 MADISON ST # 1L
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2632
Practice Address - Country:US
Practice Address - Phone:860-840-8774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care