Healthcare Provider Details

I. General information

NPI: 1558926741
Provider Name (Legal Business Name): 101 STREET ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10104 LIBERTY AVE # STOL
OZONE PARK NY
11417-1725
US

IV. Provider business mailing address

10104 LIBERTY AVE # STOL
OZONE PARK NY
11417-1725
US

V. Phone/Fax

Practice location:
  • Phone: 917-662-8913
  • Fax:
Mailing address:
  • Phone:
  • 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: WEN CAO
Title or Position: FOUNDER
Credential:
Phone: 917-662-8913