Healthcare Provider Details

I. General information

NPI: 1437528510
Provider Name (Legal Business Name): CENTRO DE AMIGOS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 BROADWAY
HAVERSTRAW NY
10927-1144
US

IV. Provider business mailing address

1208 CENTRAL AVE
UNION CITY NJ
07087-3122
US

V. Phone/Fax

Practice location:
  • Phone: 845-553-9777
  • Fax: 845-553-9776
Mailing address:
  • Phone: 201-736-6754
  • 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: ENID KARPEH
Title or Position: PRESIDENT
Credential:
Phone: 201-736-6754