MISSION OF THE IMMACULATE NPI 1750570495

NPI Information

MISSION OF THE IMMACULATE is a residential treatment facility, intellectual and/or developmental disabilities in Staten Island, 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. MISSION OF THE IMMACULATE NPI is 1750570495. The provider is registered as an organization entity type.

The provider's business location address is:

6581 HYLAN BLVD
STATEN ISLAND, NY
ZIP 10309-830
Phone: (718) 317-2803
Fax: (718) 317-2830

The provider's authorized official is Stephen W Rynn .
The authorized official title is Executive Director and has the following contact phone number (718) 317-2803.

The enumeration date for this NPI number is 10/18/2007 and was last updated on 10/18/2007.

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:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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