IndividualActive
Agnes Alexis
NPI 1669078705 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Elmont, NY
Provider details
- NPI number
- 1669078705
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Practice location
40 Elmont Rd
Elmont, NY 11003-1603
Phone: (347) 542-5644
Approximate (ZIP-level) locationGet directions
Mailing address
14202 20th Ave
Flushing, NY 11351-3000
Registry dates
- Enumerated
- 2020-12-04
- Last updated
- 2020-12-04
- Certified
- 2020-12-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.