Provider Demographics
NPI:1538367974
Name:CONGREGATION LINKED IN URBAN STRATEGY TO EFFECT RENEWAL
Entity type:Organization
Organization Name:CONGREGATION LINKED IN URBAN STRATEGY TO EFFECT RENEWAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLCHOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-963-6440
Mailing Address - Street 1:20 S BROADWAY
Mailing Address - Street 2:STE 501
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 S BROADWAY
Practice Address - Street 2:STE 501
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3713
Practice Address - Country:US
Practice Address - Phone:914-963-6440
Practice Address - Fax:914-963-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01304269Medicaid