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General NPI Number Information
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NPI Number | 1083789028
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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 | 11/22/2006
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 998 CROOKED HILL RD BUILDING #55
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City | WEST BRENTWOOD
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State | NY
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Zip | 11717-1019
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Country | US
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Telephone | 631-236-4299
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Fax | 631-235-4126
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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
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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 | 03007710
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License Number State | NY
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