| Details | Last Recertification Date | Update | Recertification | 2/1/2024 12:43:29 PM | 2/18/2025 12:39:59 PM | 2/18/2025 12:39 PM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2023 1:18:24 PM | 2/1/2024 12:43:29 PM | 2/1/2024 12:43 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Olasin, Regina
Chief Medical Officer
Care for the Homeless
2123664459-219 | Hill, Tawana
CMO
care for the homeless
2123664459 | 1/30/2024 4:20 PM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2022 4:26:51 PM | 2/2/2023 1:18:24 PM | 2/2/2023 1:18 PM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 6:41:59 AM | 2/2/2022 4:26:51 PM | 2/2/2022 4:26 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Odean, Isabel
Director of CQI and Program Implementation
Care For the Homeless
2123664459-252 | Odean, Isabel
Director of Practice Management
Care For the Homeless
2123664459-252 | 2/2/2022 9:16 AM |
| Addresses | Main Address | Update | Change Request |
1921 JEROME AVE
BRONX, NY 10453 |
1911-21 JEROME AVE
BRONX, NY 10453 | 5/20/2021 4:41 PM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 12:09:10 PM | 2/3/2021 6:41:59 AM | 2/3/2021 6:41 AM |
| Details | Entity Subname | Update | Recertification | MEDICAL CLINIC AT SUSAN'S PLACE | SUSAN'S PLACE | 2/3/2021 6:41 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Odean, Isabel
CQI and Data Manager
Care For the Homeless
2123664459-252 | Odean, Isabel
Director of CQI and Program Implementation
Care For the Homeless
2123664459-252 | 1/21/2021 10:16 AM |
| Contacts | Primary Contact | Update | Recertification | Booth, Kathryn
Nurse Manager
Care for the Homeless
2056167512 | Odean, Isabel
CQI and Data Manager
Care For the Homeless
2123664459-252 | 1/28/2020 12:09 PM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2019 7:33:40 PM | 1/28/2020 12:09:10 PM | 1/28/2020 12:09 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2018 10:01:50 AM | 2/5/2019 7:33:40 PM | 2/5/2019 7:33 PM |
| Contacts | Primary Contact | Update | Change Request | statuto, georgina
clinic admin
care for the homeless
6463798289 | Booth, Kathryn
Nurse Manager
Care for the Homeless
2056167512 | 1/14/2019 4:45 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 03064422 (NY) | | 4/3/2018 3:06 PM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1013154657 ( ) | | 4/3/2018 3:06 PM |
| Contacts | Primary Contact | Update | Recertification | Olasin, Regina
Chief Medical Officer
Care for the Homeless
2123664459-219 | statuto, georgina
clinic admin
care for the homeless
6463798289 | 2/12/2018 10:01 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2017 12:00:00 AM | 2/12/2018 10:01:50 AM | 2/12/2018 10:01 AM |
| Contacts | Authorizing Official | Update | | Olasin, Regina
Chief Medical Officer
2123664459-219 | Olasin, Regina
Chief Medical Officer
Care for the Homeless
2123664459-219 | 10/12/2017 11:45 AM |
| Contacts | Primary Contact | Update | | Olasin, Regina
Chief Medical Officer
2123664459-219 | Olasin, Regina
Chief Medical Officer
Care for the Homeless
2123664459-219 | 10/12/2017 11:45 AM |
| Contacts | Authorizing Official | Update | | WATTS, BOBBY
EXECUTIVE DIRECTOR
2123664459-201 | Olasin, Regina
Chief Medical Officer
2123664459-219 | 1/31/2017 2:17 PM |
| Contacts | Primary Contact | Update | | WATTS, BOBBY
EXECUTIVE DIRECTOR
2123664459-201 | Olasin, Regina
Chief Medical Officer
2123664459-219 | 1/31/2017 2:17 PM |
| Addresses | Main Address | Insert | | |
1921 JEROME AVE
BRONX, NY 10453 | 1/31/2017 2:15 PM |
| Details | Last Recertification Date | Update | | 2/25/2016 12:00:00 AM | 1/31/2017 12:00:00 AM | 1/31/2017 2:15 PM |
| Contacts | Authorizing Official | Insert | | | WATTS, BOBBY
EXECUTIVE DIRECTOR
2123664459-201 | 1/11/2017 10:52 AM |
| Contacts | Primary Contact | Insert | | | WATTS, BOBBY
EXECUTIVE DIRECTOR
2123664459-201 | 1/11/2017 10:52 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 2/25/2016 9:40 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 03064422 | 2/25/2016 9:40 AM |
| Medicaid Billing | Medicaid: State | Insert | | | NY | 2/25/2016 9:40 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1013154657 | 2/25/2016 9:40 AM |
| Details | Last Recertification Date | Update | | 3/3/2015 12:00:00 AM | 2/25/2016 12:00:00 AM | 2/25/2016 9:40 AM |
| Details | Last Recertification Date | Update | | 3/17/2014 12:00:00 AM | 3/3/2015 12:00:00 AM | 3/3/2015 7:57 AM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/17/2014 12:00:00 AM | 3/17/2014 12:26 PM |
| Addresses | Billing Address | Insert | | | CARE FOR THE HOMELESS
12 WEST 21ST ST. 8TH FL.
NEW YORK, NY 10010 | 3/15/2013 10:06 AM |
| Addresses | Billing Address | Update | | CARE FOR THE HOMELESS
12 WEST 21ST ST. 8TH FL.
NEW YORK, NY 10010 | CARE FOR THE HOMELESS
30 E 33rd St
FL 5
NEW YORK, NY 10016 | 3/15/2013 10:06 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/15/2013 10:06 AM |
| Details | Last Recertification Date | Insert | | | | 6/9/2009 10:40 AM |
| Details | Grant Number | Insert | | | H80CS00007 | 6/9/2009 10:40 AM |
| Details | 340B ID | Insert | | | CH02002AM | 6/9/2009 10:40 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 6/9/2009 10:40 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 6/9/2009 10:40 AM |
| Details | Medicare Provider Number | Insert | | | | 6/9/2009 10:40 AM |
| Details | Entity Name | Insert | | | CARE FOR THE HOMELESS | 6/9/2009 10:40 AM |
| Details | Program Code | Insert | | | CH | 6/9/2009 10:40 AM |
| Details | Entity Subname | Insert | | | MEDICAL CLINIC AT SUSAN'S PLACE | 6/9/2009 10:40 AM |
| Dates | Participating Approval Date | Insert | | | 6/9/2009 12:00:00 AM | 6/9/2009 10:40 AM |
| Details | State | Insert | | | Active | 6/9/2009 10:40 AM |
| Dates | Registration Date | Insert | | | 5/27/2009 12:00:00 AM | 6/9/2009 10:40 AM |
| Dates | Signed By Date | Insert | | | 3/17/2009 12:00:00 AM | 6/9/2009 10:40 AM |
| Dates | Start Date | Insert | | | 7/1/2009 12:00:00 AM | 6/9/2009 10:40 AM |
| Terminations | Termination Comments | Insert | | | | 6/9/2009 10:40 AM |
| Terminations | Termination Date | Insert | | | | 6/9/2009 10:40 AM |
| Terminations | Termination Effective Date | Insert | | | | 6/9/2009 10:40 AM |
| Terminations | Termination Reason | Insert | | | | 6/9/2009 10:40 AM |