| NPI | 1376893941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA DENISE LEWIS Cna 631-394-6639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2022-07-21 |