OrganizationActive
Mako Residence
NPI 1164540522 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Southold, NY
Provider details
- NPI number
- 1164540522
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Authorized official
- Edwin Kennedy, Cfo
- License
- 6186446 (NY)
Mailing address
380 Eds Rd
Southold, NY 11971-3716
Registry dates
- Enumerated
- 2007-03-26
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.