Provider Demographics
NPI:1932107927
Name:ACTIVE RETIREMENT COMMUNITY, INC.
Entity type:Organization
Organization Name:ACTIVE RETIREMENT COMMUNITY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CAULFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-650-2610
Mailing Address - Street 1:1 JEFFERSON FERRY DR.
Mailing Address - Street 2:
Mailing Address - City:S. SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720
Mailing Address - Country:US
Mailing Address - Phone:631-650-2600
Mailing Address - Fax:631-650-2620
Practice Address - Street 1:500 MATHER DR
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-4701
Practice Address - Country:US
Practice Address - Phone:631-650-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02287410Medicaid
NY02287410Medicaid