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Organization
MISSION OF THE IMMACULATE
Active
Organization
MISSION OF THE IMMACULATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN W RYNN (EXECUTIVE DIRECTOR)
(718) 317-2803
Entity
Organization
Contact information
Practice address
6581 HYLAN BLVD, STATEN ISLAND, NY 10309-3830
(718) 317-2803
(718) 317-2830
Mailing address
6581 HYLAN BLVD, STATEN ISLAND, NY 10309-3830
(718) 317-2803
(718) 317-2830
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
7943430
NY
Other
Enumeration date
10/18/2007
Last updated
10/18/2007
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