Healthcare Provider Details

I. General information

NPI: 1104203736
Provider Name (Legal Business Name): JAMAICA SERVICE PROGRAM FOR OLDER ADULTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92-33 170TH STREET
JAMAICA NY
11433
US

IV. Provider business mailing address

92-47 165TH STREET
JAMAICA NY
11433
US

V. Phone/Fax

Practice location:
  • Phone: 718-657-6540
  • Fax:
Mailing address:
  • Phone: 718-657-6500
  • 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: MS. BEVERLY COLLIER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 718-657-6695