Provider Demographics
NPI:1275858847
Name:MARTIN DE PORRES SCHOOL FOR EXCEPTIONAL CHILDREN
Entity Type:Organization
Organization Name:MARTIN DE PORRES SCHOOL FOR EXCEPTIONAL CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BLIXT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-596-5804
Mailing Address - Street 1:13625 218TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2226
Mailing Address - Country:US
Mailing Address - Phone:718-525-3414
Mailing Address - Fax:718-525-0986
Practice Address - Street 1:13625 218TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-2226
Practice Address - Country:US
Practice Address - Phone:718-525-3414
Practice Address - Fax:718-525-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children