Healthcare Provider Details

I. General information

NPI: 1811734643
Provider Name (Legal Business Name): SWEET HOME ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14316 41ST AVE # CF1
FLUSHING NY
11355-1866
US

IV. Provider business mailing address

7166 PARSONS BLVD APT 5F
FLUSHING NY
11365-4509
US

V. Phone/Fax

Practice location:
  • Phone: 516-474-5091
  • Fax:
Mailing address:
  • Phone:
  • 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: XIU SHI
Title or Position: MANAGER
Credential:
Phone: 516-474-5091