Healthcare Provider Details

I. General information

NPI: 1366862948
Provider Name (Legal Business Name): WONDERFUL ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13210 41ST RD 1A
FLUSHING NY
11355-4236
US

IV. Provider business mailing address

13210 41ST RD 1A
FLUSHING NY
11355-4236
US

V. Phone/Fax

Practice location:
  • Phone: 347-732-0777
  • Fax: 347-732-0750
Mailing address:
  • Phone: 347-732-0777
  • Fax: 347-732-0750

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: JING QIAN
Title or Position: PRESIDENT
Credential:
Phone: 917-705-8205