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General NPI Number Information
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NPI Number | 1609383389
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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 | 01/04/2018
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 3390 ROUTE 112 STE B
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City | MEDFORD
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State | NY
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Zip | 11763
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Country | US
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Telephone | 631-512-4092
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Fax | 631-698-0137
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Provider Business Mailing Address
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Address Line | 1 ROUTE 109 FARMINGDALE ROAD
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City | WEST BABYLON
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State | NY
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Zip | 11704-6424
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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 | 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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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