MAKO RESIDENCE NPI 1164540522

NPI Information

NPI: 1164540522
Provider Name: MAKO RESIDENCE
Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320600000X
Entity Type: Organization
Address:
380 EDS RD
SOUTHOLD, NY
ZIP 11971
Phone: (631) 665-3434
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MAKO RESIDENCE is a residential treatment facility, intellectual and/or developmental disabilities in Southold, NY. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. MAKO RESIDENCE NPI is 1164540522. The provider is registered as an organization entity type.

The provider's business location address is:

380 EDS RD
SOUTHOLD, NY
ZIP 11971-716
Phone: (631) 665-3434

The provider's authorized official is Edwin M Kennedy .
The authorized official title is Cfo and has the following contact phone number (516) 733-7000.

The enumeration date for this NPI number is 3/26/2007 and was last updated on 8/22/2020.

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		6186446	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	02245898	MEDICAID	NEW YORK
2	6186446	OTHER	NEW YORK	OPERATING CERTIFICATE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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