Healthcare Provider Details

I. General information

NPI: 1306382734
Provider Name (Legal Business Name): ACHIEVEMENT FOR DISABLED YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 UNIVERSITY AVE APT E3
BRONX NY
10452-4219
US

IV. Provider business mailing address

1090 UNIVERSITY AVE APT E3
BRONX NY
10452-4219
US

V. Phone/Fax

Practice location:
  • Phone: 646-824-3306
  • Fax:
Mailing address:
  • Phone: 646-824-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. TAMAYLA ROSS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 646-824-3306