Healthcare Provider Details

I. General information

NPI: 1902444375
Provider Name (Legal Business Name): MELROSE PLACE ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MORRIS AVE STE 1
BRONX NY
10451-4898
US

IV. Provider business mailing address

655 MORRIS AVE STE 1
BRONX NY
10451-4898
US

V. Phone/Fax

Practice location:
  • Phone: 347-879-7538
  • Fax:
Mailing address:
  • Phone: 347-879-7538
  • 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: EDWARD MORILLO
Title or Position: CO-OWNER
Credential:
Phone: 347-634-9166