Program Development Services, Inc

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

PROGRAM DEVELOPMENT SERVICES, INC

Practice address

6240 Riverdale Ave
Bronx, NY 10471-1032

Phone

(718) 601-6620

Fax

(718) 884-8574

NPI assigned

Jul 22, 2021

Organization subpart

No

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

Authorized official

Name

Dorinda Ann Derbyshire

Title

Asst. Executive Director

Phone

(718) 256-2212

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 33H046

Legal name

PROGRAM DEVELOPMENT SERVICES

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jan 29, 1990

Last certification

Jul 18, 2024

Beds

14

Ownership / control type

Private (non-profit)

Most recent change of ownership

Aug 1, 2021

Facility address

6240 Riverdale Avenue
Bronx, NY 10471

Tax ID family

Program Development Services Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Program Development Services, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Brooklyn, NY
  • NPI 1023195534
  NPD tax ID
• Program Development Services, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Brooklyn, NY
  • NPI 1194802603
  NPD tax ID

Locations

Practitioners 1

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

• Gail Marie Bergin, FNP

  • Family Nurse Practitioner
  • Bronx, NY
  • NPI 1033123823
  NPD (past)

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

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1699348094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6908 NEW UTRECHT AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112281810",
            "telephone_number": "718-256-2212",
            "fax_number": "718-256-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6240 RIVERDALE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104711032",
            "telephone_number": "718-601-6620",
            "fax_number": "718-884-8574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRAM DEVELOPMENT SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "DERBYSHIRE",
        "authorized_official_first_name": "DORINDA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ASST. EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "718-256-2212"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Voluntary or Charitable Agency in Bronx, NY
• Providers in Bronx, NY by specialty
• Voluntary or Charitable Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.