Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | NEW YORK | No |
| 2 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | NEW YORK | No |
| 3 | 251C00000X | Day Training, Developmentally Disabled Services | | | NEW YORK | No |
| 4 | 251B00000X | Case Management | | | NEW YORK | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 01492135 | OTHER | | IRE WAIVER DAY HABILITATI |
| 2 | 01997699 | OTHER | | NON-WAIVE/ISS SERVICE COO |
| 3 | 02591739 | OTHER | | WAIVER HOURLY RESPITE |
| 4 | 02171846 | OTHER | | WAIVER SUPPORTIVE EMPLOYM |
| 5 | 01997699 | OTHER | | WAIVER MSC |
| 6 | 02161508 | OTHER | | GROUP & INDIVIDUAL FAMILY |
| 7 | 01492135 | OTHER | | WAIVER/HCBS RESIDENTIAL H |
| 8 | 01750334 | OTHER | | 1377 ABBOTT RD DAY HABILI |
| 9 | 01750334 | OTHER | | ISE WAIVER RESIDENTAIL HA |
| 10 | 02161508 | OTHER | | ACT WAIVER DAY HABILITATI |
| 11 | 01492135 | OTHER | | SENIOR DAY WAIVER DAY HAB |
| 12 | 01750334 | OTHER | | PACT WAIVER RESIDENTIAL H |
| 13 | 02253469 | OTHER | | WAIVER SERVICE IRA |
| 14 | 02588663 | OTHER | | WAIVER BAKOS IRA |
| 15 | 01750334 | OTHER | | 1845 GENESEE NON DD DAY H |
| 16 | 01492135 | OTHER | | WAIVER/HCBS DAY HABILITAT |
| 17 | 02253487 | OTHER | | WAIVER SUPPORTIVE IRA |
| 18 | 02599833 | OTHER | | WAIVER LAKE IRA |
