MEDICARE: DITMAS PARK ADULT DAY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1023452141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DITMAS PARK ADULT DAY CARE LLC

Provider Business Mailing Address
First Line	:	2107 DITMAS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 E 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6902
Country	:	US
Telephone Number	:	718-907-8560
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	MR. SANDOR OBERLANDER
Credential	:
Telephone Number	:	718-907-8560

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	04/19/2013

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