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General NPI Number Information
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NPI Number | 1215246921
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Entity Type | Organization
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Legal Business Name | REWARDING ENVIRONMENTS FOR ADULT LIVING INC
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 32 BELMONT BLVD
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City | ELMONT
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State | NY
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Zip | 11003-1805
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Country | US
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Telephone | 516-354-0579
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Fax | 516-354-0579
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Provider Business Mailing Address
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Address Line | 32 BELMONT BLVD
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City | ELMONT
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State | NY
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Zip | 11003-1805
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Country | US
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Telephone | 516-354-0579
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Fax | 516-354-0579
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TRAVIS ARCHIE
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Credential | MA
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Telephone | 516-354-0579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 03184049
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License Number State | NY
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