# MEDICAID

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

## Provider details

- **NPI number:** 1609990712
- **Authorized official:** MRS. MANUELLA SILNE ALLONCE (LICENSE PRACTICAL NURSE)
- **Authorized official phone:** (516) 812-7614

## Contact information

- **Practice address:** 329 W JAMAICA AVE, VALLEY STREAM, NY 11580-5322
- **Practice address phone:** (516) 812-7614
- **Mailing address:** 329 W JAMAICA AVE, VALLEY STREAM, NY 11580-5322
- **Mailing address phone:** (516) 812-7614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 265009 | NY | Yes |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 08/22/2020