Provider Demographics
NPI:1164587069
Name:AID TO THE DEVELOPMENTALLY DISABLED
Entity Type:Organization
Organization Name:AID TO THE DEVELOPMENTALLY DISABLED
Other - Org Name:ADD, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:RIEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-727-6220
Mailing Address - Street 1:901 E MAIN ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2613
Mailing Address - Country:US
Mailing Address - Phone:631-727-6220
Mailing Address - Fax:631-727-6553
Practice Address - Street 1:700 SKUNK LN
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1519
Practice Address - Country:US
Practice Address - Phone:631-734-7719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7569443315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01068368Medicaid