NPIMap

Organization Active NPI

Developmemtal Disabilities Institute

  • Intellectual Disabilities Intermediate Care Facility
  • Sayville, NY
National Provider Identifier
1508031394
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
DEVELOPMEMTAL DISABILITIES INSTITUTE
Practice address
98 Bourne Blvd
Sayville, NY 11782-3307
Phone
(631) 366-5876
Fax
(631) 366-5893
NPI assigned
Apr 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

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

Authorized official

Name
Sophia Samuel
Title
Cfo
Phone
(631) 366-2960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

98 Bourne Blvd
Sayville, NY 11782-3307

Mailing address

99 Hollywood Dr
Smithtown, NY 11787-3135
Phone (631) 366-5876

Other identifiers 1

IdentifierTypeStateIssuer
00971155MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 33G806

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
DEVELOPMENTAL DISABILITIES INSTITUTE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 27, 1987
Last certification
Oct 30, 2025
Beds
9
Ownership / control type
Private (non-profit)
Facility address
98 Bourne Ave
Sayville, NY 11782

National Provider Directory

National Provider Directory
Tax ID family
Developmental Disabilities Institute17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440028800000",
    "number": "1508031394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 HOLLYWOOD DR",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873135",
            "telephone_number": "631-366-5876",
            "fax_number": "631-366-5893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 BOURNE BLVD",
            "city": "SAYVILLE",
            "state": "NY",
            "postal_code": "117823307",
            "telephone_number": "631-366-5876",
            "fax_number": "631-366-5893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVELOPMEMTAL DISABILITIES INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2015-08-20",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "SOPHIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "631-366-2960"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00971155",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sayville, NY

Sources for this page

Verify at the official NPI Registry.