Provider Demographics
NPI:1912575762
Name:AID TO THE DEVELOPMENTALLY DISABLED, INC
Entity Type:Organization
Organization Name:AID TO THE DEVELOPMENTALLY DISABLED, INC
Other - Org Name:RISE LIFE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-745-4189
Mailing Address - Street 1:901 E MAIN ST STE 508
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2680
Mailing Address - Country:US
Mailing Address - Phone:631-727-6220
Mailing Address - Fax:631-727-6553
Practice Address - Street 1:901 E MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2680
Practice Address - Country:US
Practice Address - Phone:631-727-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center