| NPI | 1427198209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPH FASANO Executive Director 631-758-0474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NY 7609432) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2016-05-18 |