Provider Demographics
NPI:1750804951
Name:IRI: INNOVATIVE RESOURCES FOR INDEPENDENCE
Entity type:Organization
Organization Name:IRI: INNOVATIVE RESOURCES FOR INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIR OF ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGALEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-805-6796
Mailing Address - Street 1:112-40 FRANCIS LEWIS BLVD.
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2235
Mailing Address - Country:US
Mailing Address - Phone:718-805-6796
Mailing Address - Fax:718-776-2724
Practice Address - Street 1:922 RAINBOW COMMONS CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:718-805-6796
Practice Address - Fax:718-776-3858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid