NPIMap

Organization Active NPI

Institute for Community Living , Inc.

  • Community/Behavioral Health Agency
  • Rosedale, NY
National Provider Identifier
1427105857
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
057800 Issued in NY
Legal business name
INSTITUTE FOR COMMUNITY LIVING , INC.
Practice address
13607 Brookville Blvd
Rosedale, NY 11422-1525
Phone
(718) 855-7485
NPI assigned
Jan 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Renie Elizabeth Marie Rondon Jackson, LCSWNPI 1730351578
Title
Clinic Director
Phone
(718) 855-7485

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 057800 NY Primary

Addresses

Primary practice location

13607 Brookville Blvd
Rosedale, NY 11422-1525

Mailing address

136 Rockville Blvd
Rosedale, NY 11422-0000
Phone (718) 855-7485

National Provider Directory

National Provider Directory
Tax ID family
Icl Individual Support Services35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427105857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 ROCKVILLE BLVD",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114220000",
            "telephone_number": "718-855-7485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13607 BROOKVILLE BLVD",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114221525",
            "telephone_number": "718-855-7485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR COMMUNITY LIVING , INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RONDON JACKSON",
        "authorized_official_first_name": "RENIE",
        "authorized_official_middle_name": "ELIZABETH MARIE",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "718-855-7485",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": "057800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rosedale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.