Healthcare Provider Details

I. General information

NPI: 1376975664
Provider Name (Legal Business Name): CORONA ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10717 NORTHERN BLVD
CORONA NY
11368-1235
US

IV. Provider business mailing address

10717 NORTHERN BLVD
CORONA NY
11368-1235
US

V. Phone/Fax

Practice location:
  • Phone: 917-567-0235
  • Fax:
Mailing address:
  • Phone: 917-567-0235
  • 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. NAT COLES
Title or Position: CEO
Credential:
Phone: 201-562-8317