Healthcare Provider Details

I. General information

NPI: 1265963318
Provider Name (Legal Business Name): WOODHAVEN LIFESTYLE SENIOR CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 86TH AVE
JAMAICA NY
11421-1207
US

IV. Provider business mailing address

8507 86TH AVE
JAMAICA NY
11421-1207
US

V. Phone/Fax

Practice location:
  • Phone: 347-409-8698
  • Fax:
Mailing address:
  • Phone: 347-409-8698
  • 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: HUIKE XU
Title or Position: DIRECTOR
Credential:
Phone: 347-409-8698