MEDICARE: SECOND HOME SOCIAL ADULT DAY CARE OF 86 STREET 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1922396118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND HOME SOCIAL ADULT DAY CARE OF 86 STREET LLC

Provider Business Mailing Address
First Line	:	2444 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4415
Country	:	US
Telephone Number	:	718-517-2444
Fax Number	:	718-266-0707

Provider Business Practice Location Address
First Line	:	2444 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4415
Country	:	US
Telephone Number	:	718-517-2444
Fax Number	:	718-266-0707

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VLADIMIR ZBOROVSKY
Credential	:
Telephone Number	:	718-517-2444

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	07/21/2011

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