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NPI Code Detail

MEDICARE: SECOND HOME SOCIAL ADULT DAY CARE

MEDICARE: SECOND HOME 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
1261QA0600XAdult Day Care Clinic/Center

General Provider Information

NPI Number : 1336447515
Entity Type Code : Organization
Provider Name (Legal Business Name) : SECOND HOME SOCIAL ADULT DAY CARE
Provider Business Mailing Address
First Line : 4102 13TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-1389
Country : US
Telephone Number : 718-517-2400
Fax Number : 718-484-4017
Provider Business Practice Location Address
First Line : 4102 13TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-1389
Country : US
Telephone Number : 718-517-2400
Fax Number : 718-484-4017
Authorized Official
Title or Position : MANAGER
Name : MR. ALEX VISHNEVSKIY
Credential :
Telephone Number : 718-517-2400
Provider Enumeration Date : 03/11/2011
Last Update Date : 03/11/2011

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Directions to “SECOND HOME SOCIAL ADULT DAY CARE ” Practice Location

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