# BUSTAMONTE RESIDENCE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134240831
- **Authorized official:** EDWIN M KENNEDY (CFO)
- **Authorized official phone:** (516) 733-7000

## Contact information

- **Practice address:** 664 ALBIN AVE, WEST BABYLON, NY 11704-7402
- **Practice address phone:** (631) 665-3434
- **Mailing address:** 664 ALBIN AVE, WEST BABYLON, NY 11704-7402
- **Mailing address phone:** (631) 665-3434

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 6186452 | NY | Yes |

## Other

- **Enumeration date:** 04/02/2007
- **Last updated:** 08/22/2020