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Mother Theresa Residence

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

NPI 1780705384 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1780705384
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
License
6186451 (NY)
Legal business name
MOTHER THERESA RESIDENCE
Practice address
339 County Line Rd
Amityville, NY 11701-2920
Phone
(631) 665-3434
NPI assigned
Apr 2, 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)

Locations

339 County Line Rd
Amityville, NY 11701

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 6186451 NY Yes

Addresses

Primary practice location

339 County Line Rd
Amityville, NY 11701-2920

Mailing address

339 County Line Rd
Amityville, NY 11701-2920
Phone (631) 665-3434

Other identifiers

IdentifierTypeStateIssuer
02245930MedicaidNY

Other providers in Amityville, NY

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

Sources for this page

Verify at the official NPI Registry.