M&D Residential Services, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

151446 Issued in FL

Legal business name

M&D RESIDENTIAL SERVICES, INC

Practice address

2556 SW Monterrey LN
Port St Lucie, FL 34953-2956

Phone

(772) 807-1205

NPI assigned

Nov 8, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Densil A Reynolds

Title

President

Phone

(772) 807-1250

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289174400000",
    "number": "1821399890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2556 SW MONTERREY LN",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349532956",
            "telephone_number": "772-807-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2556 SW MONTERREY LN",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349532956",
            "telephone_number": "772-807-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M&D RESIDENTIAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-08",
        "last_updated": "2010-11-08",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "DENSIL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-807-1250",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "151446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "686560796",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leo Lundy III, BA
• Leivaughn Lyn
• Christina Lynch
• Lynne C Erbe OD PA
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• Ma Maison LLC (Claire Labatte AFCH)
• Ma Maison LLC
• Carole Jean Mabus, CAROLE MABUS
• Jessica Lyn Macchione

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.