Healthcare Provider Details

I. General information

NPI: 1023574746
Provider Name (Legal Business Name): BETWEEN AGES ADULT SOCIAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MEMORIAL HWY STE 1-3
NEW ROCHELLE NY
10801-5639
US

IV. Provider business mailing address

175 MEMORIAL HWY STE 1-3
NEW ROCHELLE NY
10801-5639
US

V. Phone/Fax

Practice location:
  • Phone: 914-740-5160
  • Fax: 914-740-5161
Mailing address:
  • Phone: 914-740-5160
  • Fax: 914-740-5161

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: MRS. MCKEISHA RICHARDSON
Title or Position: CEO/DIRECTOR
Credential:
Phone: 914-223-0553