NPIMap

Organization Active NPI

Risewell Community Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Medford, NY
National Provider Identifier
1609383389
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
RISEWELL COMMUNITY SERVICES
Practice address
3390 Route 112 Ste B
Medford, NY 11763
Phone
(631) 512-4092
Fax
(631) 698-0137
NPI assigned
Jan 4, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Authorized official

Name
Stephen McCarthy, CFO
Title
Chief Financial Officer
Phone
(631) 669-5355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

3390 Route 112 Ste B
Medford, NY 11763

Mailing address

1 Route 109 Farmingdale Road
West Babylon, NY 11704-6424
Phone (631) 669-5355

Other identifiers 1

IdentifierTypeStateIssuer
02716952MedicaidNY

Other names 1

  • Federation of Organizations for th NYS Mentally Disabled Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Federation of Organizations30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Locations

3390 Route 112
Ste B
Medford, NY 11763
Phone (631) 512-4092

1 Route 109
West Babylon, NY 11704
Phone (631) 236-4325

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1609383389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ROUTE 109 FARMINGDALE ROAD",
            "city": "WEST BABYLON",
            "state": "NY",
            "postal_code": "117046424",
            "telephone_number": "631-669-5355",
            "fax_number": "631-669-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3390 ROUTE 112 STE B",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "11763",
            "telephone_number": "631-512-4092",
            "fax_number": "631-698-0137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RISEWELL COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-04",
        "last_updated": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "631-669-5355",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02716952",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Federation of Organizations for th NYS Mentally Disabled",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Medford, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.