Healthcare Provider Details

I. General information

NPI: 1942703574
Provider Name (Legal Business Name): QUEENS SOCIAL ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14841 HILLSIDE AVE
JAMAICA NY
11435-3330
US

IV. Provider business mailing address

14841 HILLSIDE AVE
JAMAICA NY
11435-3330
US

V. Phone/Fax

Practice location:
  • Phone: 718-647-4444
  • Fax: 347-694-8854
Mailing address:
  • Phone: 718-647-4444
  • Fax: 347-694-8854

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: MAHFUZUL HAQUE
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-647-4444