Healthcare Provider Details

I. General information

NPI: 1174866602
Provider Name (Legal Business Name): HEALTHY LIVING ADHC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162-04 JAMAICA AVENUE, 4TH FLOOR
JAMAICA NY
11432
US

IV. Provider business mailing address

162-04 JAMAICA AVENUE 4TH FLOOR
JAMAICA NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 347-458-1866
  • Fax:
Mailing address:
  • Phone: 347-458-1866
  • 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. LYNN PHAM
Title or Position: DIRECTOR
Credential:
Phone: 347-458-1866