187 Cottage Avenue Corp
NPI #1447663067 in Mount Vernon, New York
Provider Information
- NPI Number
- 1447663067
- Entity Type
- Organization
- Organization Name
- 187 Cottage Avenue Corp
- Primary Specialty
- Community Based Residential Treatment Facility, Mental Illness
- Enumeration Date
- Jun 11, 2014
- Last Updated
- Jun 11, 2014
Practice Location
- Address
- 187 COTTAGE AVE
- City
- Mount Vernon
- State
- New York
- ZIP Code
- 10550-1446
- Phone
- (914) 664-5046
Authorized Official
- Name
- MR. DAVID ELISHA GRANT JR.
- Title
- ADMINISTRATOR
- Phone
- (914) 699-4294
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Mental Illness |
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