Healthcare Provider Details

I. General information

NPI: 1255822052
Provider Name (Legal Business Name): CENTRAL PARK WEST CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115-119 LENOX AVENUE
NEW YORK NY
11026
US

IV. Provider business mailing address

13677 ROOSEVELT AVE # 2A
FLUSHING NY
11354-5585
US

V. Phone/Fax

Practice location:
  • Phone: 718-358-5800
  • Fax:
Mailing address:
  • Phone: 718-358-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. RUTH TSE-HSIN WU
Title or Position: OWNER
Credential:
Phone: 718-358-5800