Healthcare Provider Details

I. General information

NPI: 1972991693
Provider Name (Legal Business Name): NORTHERN ADULT DAY CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EAST 124TH STREET 5TH FLOOR
NEW YORK NY
10035
US

IV. Provider business mailing address

116 EAST 124TH STREET 5TH FLOOR
NEW YORK NY
10035
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-1284
  • Fax:
Mailing address:
  • Phone: 212-426-1284
  • 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: VERNA FITZPATRICK
Title or Position: ADMINISTRATOR
Credential:
Phone: 917-623-4167