OrganizationActive
Fagan Residence
NPI 1730209362 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Elmont, NY
Provider details
- NPI number
- 1730209362
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Edwin Kennedy, Cfo(516) 733-7000
- License
- 6186445 (NY)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense 6186445 (NY)
Residential Treatment Facilities
Practice location
1504 Depaul St
Elmont, NY 11003-1900
Phone: (631) 665-3434
Approximate (ZIP-level) locationGet directions
Mailing address
1504 Depaul St
Elmont, NY 11003-1900
Registry dates
- Enumerated
- 2007-03-29
- 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.