Healthcare Provider Details

I. General information

NPI: 1598425423
Provider Name (Legal Business Name): CENTERCARE SOCIAL ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 132ND AVE
JAMAICA NY
11434-2949
US

IV. Provider business mailing address

31 HUNT CT
JERICHO NY
11753-1139
US

V. Phone/Fax

Practice location:
  • Phone: 718-902-1386
  • Fax:
Mailing address:
  • Phone: 718-902-1386
  • 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: ZACK CHEUNG
Title or Position: CFO
Credential:
Phone: 718-902-1386