Healthcare Provider Details

I. General information

NPI: 1417723529
Provider Name (Legal Business Name): CORONA COMMUNITY SENIOR CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10802 OTIS AVE
CORONA NY
11368-3914
US

IV. Provider business mailing address

5515 VAN CLEEF ST
CORONA NY
11368-3907
US

V. Phone/Fax

Practice location:
  • Phone: 929-575-0958
  • Fax: 718-271-6478
Mailing address:
  • Phone: 718-271-1678
  • Fax: 718-271-6478

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: JINLAN LU
Title or Position: MANAGER
Credential:
Phone: 929-253-6668