Healthcare Provider Details

I. General information

NPI: 1083120604
Provider Name (Legal Business Name): ZAMZAM SOCIAL ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15015 HILLSIDE AVE
JAMAICA NY
11432-3319
US

IV. Provider business mailing address

15015 HILLSIDE AVE
JAMAICA NY
11432-3319
US

V. Phone/Fax

Practice location:
  • Phone: 347-658-9750
  • Fax:
Mailing address:
  • Phone: 347-658-9750
  • 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: MR. MICHAEL C PRYOR
Title or Position: MANAGING MEMBER
Credential: NA
Phone: 347-658-9750