Provider Demographics
NPI:1265674303
Name:ADULTS AND CHILDREN WITH LEARNING AND DEVELOPMENTAL DISABILITES, INC.
Entity Type:Organization
Organization Name:ADULTS AND CHILDREN WITH LEARNING AND DEVELOPMENTAL DISABILITES, INC.
Other - Org Name:ACLD
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, HEALTH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CREAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-822-0028
Mailing Address - Street 1:807 S OYSTER BAY RD
Mailing Address - Street 2:HEALTH SERVICES, ART 16
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-1030
Mailing Address - Country:US
Mailing Address - Phone:516-822-0028
Mailing Address - Fax:516-342-2480
Practice Address - Street 1:807 S OYSTER BAY RD
Practice Address - Street 2:HEALTH SERVICES, ART 16
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1030
Practice Address - Country:US
Practice Address - Phone:516-822-0028
Practice Address - Fax:516-342-2480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADULTS AND CHILDREN WITH LEARNING AND DEVELOPMENTAL DISABILITES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-06
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities