Healthcare Provider Details

I. General information

NPI: 1871167262
Provider Name (Legal Business Name): 117 SADC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E 117TH ST
NEW YORK NY
10035-4814
US

IV. Provider business mailing address

213 E 117TH ST
NEW YORK NY
10035-4814
US

V. Phone/Fax

Practice location:
  • Phone: 347-348-8790
  • Fax:
Mailing address:
  • Phone: 347-348-8790
  • 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: HANNAH K HONG
Title or Position: CHIEF EXECUTIVE OFFICER (CEO)
Credential:
Phone: 347-348-8790