Healthcare Provider Details

I. General information

NPI: 1700249760
Provider Name (Legal Business Name): ACTIVE RETIREMENT COMMUNITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MATHER DR
SOUTH SETAUKET NY
11720-4701
US

IV. Provider business mailing address

1 JEFFERSON FERRY DR
SOUTH SETAUKET NY
11720-4708
US

V. Phone/Fax

Practice location:
  • Phone: 631-650-2700
  • Fax:
Mailing address:
  • Phone: 631-650-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5151317N
License Number StateNY

VIII. Authorized Official

Name: BRIAN AMTMANN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 631-650-2724