Provider Demographics
NPI:1700819299
Name:DEVELOPMENTAL DISABILITIES INSTITUTE, INC
Entity Type:Organization
Organization Name:DEVELOPMENTAL DISABILITIES INSTITUTE, INC
Other - Org Name:IRA
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANN-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-366-2960
Mailing Address - Street 1:99 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3135
Mailing Address - Country:US
Mailing Address - Phone:631-366-2900
Mailing Address - Fax:631-366-2996
Practice Address - Street 1:99 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3135
Practice Address - Country:US
Practice Address - Phone:631-366-2900
Practice Address - Fax:631-366-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities