Fagan Residence

LBN: Fagan Residence
Fagan Residence is an health care organization with primary practice located at 1504 Depaul St , Elmont NY 11003-1900. The organization recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as the primary health care specialty. Fagan Residence can be contacted via phone (631) 665-3434, or through Kennedy, Edwin M via phone (516) 733-7000.

Contact Information

Primary practice address
1504 Depaul St Elmont NY 11003-1900
Phone: (631) 665-3434
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Kennedy, Edwin M
Phone: (516) 733-7000

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X 6186445 New York

Profile Details

NPI number 1730209362
LBN Legal business name Fagan Residence
DBA Doing business as
Authorized official Kennedy, Edwin M
Entity Organization
Organization subpart 1 No
Enumeration date Mar 29th, 2007
Last updated Aug 22nd, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730209362 NPPES
New York MEDICAID 02245930

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