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General NPI Number Information
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NPI Number | 1689733008
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Entity Type | Organization
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Legal Business Name | COMMUNITY RESOURCE CENTER FOR THE DEVELOPMENTALLY DISABLED, INC.
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 2253 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10035-2206
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Country | US
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Telephone | 718-292-1705
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Fax |
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Provider Business Mailing Address
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Address Line | 378 E 151ST ST
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City | BRONX
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State | NY
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Zip | 10455-2603
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Country | US
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Telephone | 718-292-1705
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KEVIN M MEADE
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Credential |
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Telephone | 718-292-1705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State | NY
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