# MISSION OF THE IMMACULATE

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

## Provider details

- **NPI number:** 1750570495
- **Authorized official:** MR. STEPHEN W RYNN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (718) 317-2803

## Contact information

- **Practice address:** 6581 HYLAN BLVD, STATEN ISLAND, NY 10309-3830
- **Practice address phone:** (718) 317-2803
- **Practice address fax:** (718) 317-2830
- **Mailing address:** 6581 HYLAN BLVD, STATEN ISLAND, NY 10309-3830
- **Mailing address phone:** (718) 317-2803
- **Mailing address fax:** (718) 317-2830

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 7943430 | NY | Yes |

## Other

- **Enumeration date:** 10/18/2007
- **Last updated:** 10/18/2007