Provider Demographics
NPI:1891864179
Name:NEW YAORK STATE ASSOCIATION FOR RETARDED CHILDREN INC - NASSAU COUNTY
Entity Type:Organization
Organization Name:NEW YAORK STATE ASSOCIATION FOR RETARDED CHILDREN INC - NASSAU COUNTY
Other - Org Name:AHRC HELP OF RETARDED CHILDREN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-626-1075
Mailing Address - Street 1:189 WHEATLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11545-8641
Mailing Address - Country:US
Mailing Address - Phone:516-626-1075
Mailing Address - Fax:516-396-9766
Practice Address - Street 1:115 E BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4221
Practice Address - Country:US
Practice Address - Phone:516-626-1075
Practice Address - Fax:516-396-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01476806Medicaid
NYW8D361Medicare ID - Type UnspecifiedMEDICARE ID