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General NPI Number Information
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NPI Number | 1013363092
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Entity Type | Organization
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Legal Business Name | RISEWELL COMMUNITY SERVICES
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 11606 MYRTLE AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-1748
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Country | US
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Telephone | 718-850-7099
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Fax | 718-850-9361
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Provider Business Mailing Address
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Address Line | 1 FARMINGDALE ROAD/ROUTE 109
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City | WEST BABYLON
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State | NY
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Zip | 11704-6545
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Country | US
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Telephone | 631-669-5355
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Fax | 631-669-1114
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. STEPHEN MCCARTHY
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Credential | CFO
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Telephone | 631-669-5355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NY
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