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General NPI Number Information
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NPI Number | 1063419356
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Entity Type | Organization
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Legal Business Name | MARIA REGINA RESIDENCE, INC.
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 1725 BRENTWOOD RD BLDG 1
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City | BRENTWOOD
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State | NY
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Zip | 11717-5543
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Country | US
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Telephone | 631-299-3000
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Fax | 631-299-3274
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Provider Business Mailing Address
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Address Line | 1725 BRENTWOOD RD BLDG 1
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City | BRENTWOOD
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State | NY
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Zip | 11717-5543
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Country | US
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Telephone | 845-447-1542
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Fax | 845-447-1544
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Authorized Official
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Title or Position | CFO
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Name | ILANA AVINARI
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Credential |
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Telephone | 845-447-1542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5154321N
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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