Healthcare Provider Details

I. General information

NPI: 1366713208
Provider Name (Legal Business Name): SPRINGVALLEY ADULT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 S PASCACK RD
NANUET NY
10954-5981
US

IV. Provider business mailing address

184 S PASCACK RD
NANUET NY
10954-5981
US

V. Phone/Fax

Practice location:
  • Phone: 845-623-5040
  • Fax:
Mailing address:
  • Phone: 845-623-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number620-F-071
License Number StateNY

VIII. Authorized Official

Name: MRS. MYRNA A DAOS
Title or Position: ADMINISTRATOR
Credential:
Phone: 845-623-5040