Provider Demographics
NPI:1215246921
Name:REWARDING ENVIRONMENTS FOR ADULT LIVING INC
Entity type:Organization
Organization Name:REWARDING ENVIRONMENTS FOR ADULT LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:516-354-0579
Mailing Address - Street 1:32 BELMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1805
Mailing Address - Country:US
Mailing Address - Phone:516-354-0579
Mailing Address - Fax:516-354-0579
Practice Address - Street 1:32 BELMONT BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1805
Practice Address - Country:US
Practice Address - Phone:516-354-0579
Practice Address - Fax:516-354-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03184049251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03184049Medicaid