Healthcare Provider Details

I. General information

NPI: 1972362853
Provider Name (Legal Business Name): GRANDVIDA ADULT DAY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 WILLIAMSBRIDGE RD
BRONX NY
10461-1604
US

IV. Provider business mailing address

34 PETERSVILLE RD
NEW ROCHELLE NY
10801-4438
US

V. Phone/Fax

Practice location:
  • Phone: 718-576-1962
  • Fax:
Mailing address:
  • Phone: 845-636-0687
  • 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. JUANLUIS ELIZA II
Title or Position: PRESIDENT
Credential:
Phone: 845-636-0687