Provider Demographics
NPI:1932107927
Name:ACTIVE RETIREMENT COMMUNITY, INC.
Entity Type:Organization
Organization Name:ACTIVE RETIREMENT COMMUNITY, INC.
Other - Org Name:JEFFERSON'S FERRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-650-2610
Mailing Address - Street 1:1 JEFFERSON FERRY DR.
Mailing Address - Street 2:
Mailing Address - City:S. SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720
Mailing Address - Country:US
Mailing Address - Phone:631-650-2600
Mailing Address - Fax:631-650-2620
Practice Address - Street 1:500 MATHER DR
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-4701
Practice Address - Country:US
Practice Address - Phone:631-650-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5151317N310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02287410Medicaid
NY02287410Medicaid