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General NPI Number Information
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NPI Number | 1750804951
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Entity Type | Organization
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Legal Business Name | IRI: INNOVATIVE RESOURCES FOR INDEPENDENCE
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 922 RAINBOW COMMONS CT
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City | MELVILLE
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State | NY
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Zip | 11747
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Country | US
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Telephone | 718-805-6796
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Fax | 718-776-3858
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Provider Business Mailing Address
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Address Line | 112-40 FRANCIS LEWIS BLVD.
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-2235
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Country | US
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Telephone | 718-805-6796
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Fax | 718-776-2724
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Authorized Official
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Title or Position | ASSOCIATE EXECUTIVE DIR OF ADMIN
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Name | MR. JAMES MAGALEE
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Credential |
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Telephone | 718-805-6796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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