Healthcare Provider Details

I. General information

NPI: 1902355431
Provider Name (Legal Business Name): LIVINGWELL DAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13781 NORTHERN BLVD
FLUSHING NY
11354-4320
US

IV. Provider business mailing address

13781 NORTHERN BLVD
FLUSHING NY
11354-4320
US

V. Phone/Fax

Practice location:
  • Phone: 929-362-2477
  • Fax: 929-362-2451
Mailing address:
  • Phone: 929-362-2477
  • Fax: 929-362-2451

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. JIEMIN SHANG
Title or Position: PRESIDENT
Credential:
Phone: 347-395-7768