Healthcare Provider Details

I. General information

NPI: 1134982143
Provider Name (Legal Business Name): CASA DE AMIGOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023A JUNCTION BLVD
CORONA NY
11368-2123
US

IV. Provider business mailing address

14009 33RD AVE APT 2R
FLUSHING NY
11354-3169
US

V. Phone/Fax

Practice location:
  • Phone: 929-789-2760
  • Fax:
Mailing address:
  • Phone: 929-393-3003
  • 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: ZHENG WANG
Title or Position: PRESIDENT
Credential:
Phone: 929-393-3003