Healthcare Provider Details

I. General information

NPI: 1306254123
Provider Name (Legal Business Name): LULU'S SOCIAL ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BRONXWOOD AVE
BRONX NY
10469
US

IV. Provider business mailing address

511 E 80TH ST APT 4E
NEW YORK NY
10075-0746
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-2252
  • Fax:
Mailing address:
  • Phone: 917-747-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL BERKE
Title or Position: MANAGER
Credential:
Phone: 917-747-4263