Healthcare Provider Details

I. General information

NPI: 1679556450
Provider Name (Legal Business Name): VILLAGE CENTER FOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 20TH ST
NEW YORK NY
10011-3641
US

IV. Provider business mailing address

120 BROADWAY SUITE 2840
NEW YORK NY
10271-0009
US

V. Phone/Fax

Practice location:
  • Phone: 212-337-9221
  • Fax: 212-633-6587
Mailing address:
  • Phone: 212-337-5710
  • Fax: 212-337-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number7002335N
License Number StateNY

VIII. Authorized Official

Name: DEBRA TIRADO
Title or Position: CFO
Credential:
Phone: 212-337-5710