Organization
CHRISTOPHER RESIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN M KENNEDY (CFO)
(516) 733-7000
Entity
Organization
Contact information
Practice address
70 MCKEON AVE, VALLEY STREAM, NY 11580-3904
(631) 665-3434
Mailing address
70 MCKEON AVE, VALLEY STREAM, NY 11580-3904
(631) 665-3434
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
6186440
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02245930
—
NY
Enumeration date
03/29/2007
Last updated
08/22/2020
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