Healthcare Provider Details

I. General information

NPI: 1386060705
Provider Name (Legal Business Name): ELIM ADULT DAYCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 162ND ST
FLUSHING NY
11358-3157
US

IV. Provider business mailing address

4565 162ND ST
FLUSHING NY
11358-3157
US

V. Phone/Fax

Practice location:
  • Phone: 718-938-1777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MAN H. LEE
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 718-938-1777