Healthcare Provider Details

I. General information

NPI: 1801457080
Provider Name (Legal Business Name): FAMILY ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2332 HOFFMAN STREET, 2ND & 3RD FLOOR
BRONX NY
10458
US

IV. Provider business mailing address

2330 HOFFMAN ST FL 3
BRONX NY
10458-8003
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-2488
  • Fax: 718-933-2499
Mailing address:
  • Phone: 718-933-2488
  • Fax: 718-933-2499

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: MS. MISSY MOON
Title or Position: PRESIDENT
Credential:
Phone: 718-933-2488