Healthcare Provider Details

I. General information

NPI: 1710641865
Provider Name (Legal Business Name): WONDERFUL SENIOR PROGRAM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13419 BLOSSOM AVE FL 1
FLUSHING NY
11355-4893
US

IV. Provider business mailing address

13419 BLOSSOM AVE
FLUSHING NY
11355-4893
US

V. Phone/Fax

Practice location:
  • Phone: 929-202-3377
  • Fax: 347-246-0478
Mailing address:
  • Phone: 929-202-3377
  • Fax: 347-246-0478

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: ZHONG REN LIU
Title or Position: OWNER
Credential:
Phone: 929-202-3377