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General NPI Number Information
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NPI Number | 1083898845
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND AID FOR RETARDED CHILDREN, INC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 3450 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6721
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Country | US
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Telephone | 718-447-5200
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Fax | 718-448-6939
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Provider Business Mailing Address
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Address Line | 3450 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6721
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Country | US
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Telephone | 718-447-5200
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Fax | 718-448-6939
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | MR. DANA THOMAS MAGEE
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Credential | CEO/EXECUTIVE DIRECT
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Telephone | 718-447-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 6669300
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 28330
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License Number State | NY
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