Provider Demographics
NPI:1902330228
Name:689 SOUTH 16TH STREET CORP
Entity Type:Organization
Organization Name:689 SOUTH 16TH STREET CORP
Other - Org Name:EMERGENCY HOUSING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAC EVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-271-5802
Mailing Address - Street 1:555 PASSAIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006
Mailing Address - Country:US
Mailing Address - Phone:973-808-9300
Mailing Address - Fax:
Practice Address - Street 1:555 PASSAIC AVENUE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006
Practice Address - Country:US
Practice Address - Phone:973-808-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)