Healthcare Provider Details

I. General information

NPI: 1215277587
Provider Name (Legal Business Name): FOREST DAY CARE SOCIAL PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 DOUGHTY BLVD
INWOOD NY
11096-1344
US

IV. Provider business mailing address

457 DOUGHTY BOULEVARD
INWOOD NY
11096
US

V. Phone/Fax

Practice location:
  • Phone: 516-239-1111
  • Fax: 516-371-1714
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: ELLEN GORDON
Title or Position: DIRECTOR
Credential: R.N
Phone: 516-239-1111