Healthcare Provider Details

I. General information

NPI: 1932107927
Provider Name (Legal Business Name): ACTIVE RETIREMENT COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
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.
S. SETAUKET NY
11720
US

V. Phone/Fax

Practice location:
  • Phone: 631-650-2700
  • Fax:
Mailing address:
  • Phone: 631-650-2600
  • Fax: 631-650-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CAULFIELD
Title or Position: PRESIDENT / CEO
Credential:
Phone: 631-650-2610