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Mako Residence

Organization Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Southold, NY

NPI 1164540522 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1164540522
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
License
6186446 (NY)
Legal business name
MAKO RESIDENCE
Practice address
380 Eds Rd
Southold, NY 11971-3716
Phone
(631) 665-3434
NPI assigned
Mar 26, 2007
Organization subpart
No

Authorized official

Name
Edwin M Kennedy
Title
Cfo
Phone
(516) 733-7000

Corporate family (same tax ID) 25

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Catholic Charities of the Diocese of Rockville Centre (26 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 6186446 NY Yes

Addresses

Primary practice location

380 Eds Rd
Southold, NY 11971-3716

Mailing address

380 Eds Rd
Southold, NY 11971-3716
Phone (631) 665-3434

Other identifiers

IdentifierTypeStateIssuer
02245898MedicaidNY
6186446OtherNYOPERATING CERTIFICATE

Other providers in Southold, NY

All providers in Southold, NY · Intellectual and/or Developmental Disabilities Residential Treatment Facility in New York

Sources for this page

Verify at the official NPI Registry.