Fagan Residence

NPI 1730209362 - Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities - 320600000X

NPI Details
NPI 1730209362
Enumeration Date 03/29/2007
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name EDWIN M EDWIN
Position CFO
Phone (631) 665-3434
Fax
Practice Location
1504 DEPAUL ST
ELMONT NY, 11003-1900, US
Phone (631) 665-3434
Fax
Business Location
1504 DEPAUL ST
ELMONT NY, 11003-1900, US
Phone (631) 665-3434
Fax
Toxanomy
Taxonomy Code 320600000X
License State New York
License Number 6186445
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According to our database, Fagan Residence NPI is 1730209362, taxonomy code is 320600000X and license number is 6186445, license state is located at New York. Fagan Residence physically located at 1504 Depaul St, Elmont NY, 11003-1900. NPI Number 1033115704 has the healthcare provider type.

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1730209362 NPI number is provided on an as is basis without warranty of any kind. 1730209362 is maintained by the National Plan & Provider Enumeration System. The contents of Fagan Residence are for informational purposes only.