MEDICARE: RISHAVENA SOCIAL ADULT DAY CARE

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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1083011217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISHAVENA SOCIAL ADULT DAY CARE

Provider Business Mailing Address
First Line	:	2260 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4516
Country	:	US
Telephone Number	:	718-251-1231
Fax Number	:	347-702-7243

Provider Business Practice Location Address
First Line	:	2260 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4516
Country	:	US
Telephone Number	:	718-251-1231
Fax Number	:	347-702-7243

Authorized Official
Title or Position	:	NURSE ADMINISTRATOR
Name	:	VENA LAURENT
Credential	:	R.N. D.O.N.
Telephone Number	:	718-251-1231

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	12/03/2014

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