Provider Demographics
NPI:1114182284
Name:FAMILY RESIDENCES & ESSENTIAL ENTERPRISES, INC
Entity Type:Organization
Organization Name:FAMILY RESIDENCES & ESSENTIAL ENTERPRISES, INC
Other - Org Name:FREE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-870-1600
Mailing Address - Street 1:191 SWEET HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1342
Mailing Address - Country:US
Mailing Address - Phone:516-870-1600
Mailing Address - Fax:
Practice Address - Street 1:191 SWEET HOLLOW RD
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1342
Practice Address - Country:US
Practice Address - Phone:516-870-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01873743Medicaid