MEDICARE: RICHMOND CHILDRENS CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1467752048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND CHILDRENS CENTER INC

Provider Business Mailing Address
First Line	:	272 N BEDFORD RD
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-1103
Country	:	US
Telephone Number	:	914-471-4100
Fax Number	:	914-471-4101

Provider Business Practice Location Address
First Line	:	2820 LEXINGTON AVE
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1846
Country	:	US
Telephone Number	:	914-471-4100
Fax Number	:	914-471-4101

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. EDWARD T SPAUSTER
Credential	:	PHD
Telephone Number	:	914-471-4110

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	10/28/2010

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