Healthcare Provider Details

I. General information

NPI: 1437385879
Provider Name (Legal Business Name): TEACHING FAMILY PLAINVIEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SUNRISE ST
PLAINVIEW NY
11803-4613
US

IV. Provider business mailing address

90 CHERRY LN
HICKSVILLE NY
11801-6232
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-5902
  • Fax:
Mailing address:
  • Phone: 516-733-7040
  • Fax: 516-733-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01303497
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MR. EDWIN M KENNEDY
Title or Position: CFO
Credential:
Phone: 516-733-7040