Provider Demographics
NPI:1770978983
Name:PERSON CENTERED CARE SERVICES INC
Entity type:Organization
Organization Name:PERSON CENTERED CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHIONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-370-1088
Mailing Address - Street 1:150 GRANITE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2718
Mailing Address - Country:US
Mailing Address - Phone:718-370-1088
Mailing Address - Fax:
Practice Address - Street 1:150 GRANITE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2718
Practice Address - Country:US
Practice Address - Phone:718-370-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X, 251C00000X, 320900000X
251S00000X, 385HR2060X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03762094OtherMEDICAID PROVIDER ID
NY02725139OtherMEDICAID PROVIDER ID
NY02750076OtherMEDICAID PROVIDER ID
NY02952876OtherMEDICAID PROVIDER ID
NY02749686OtherMEDICAID PROVIDER ID
NY02750549OtherMEDICAID PROVIDER ID