Healthcare Provider Details

I. General information

NPI: 1851893465
Provider Name (Legal Business Name): TROPICAL PARADISE ADULT DAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9343 104TH ST
OZONE PARK NY
11416-1740
US

IV. Provider business mailing address

11275 SEA VIEW AVE 3G
BROOKLYN NY
11239-2714
US

V. Phone/Fax

Practice location:
  • Phone: 917-470-4720
  • Fax:
Mailing address:
  • Phone: 917-470-4720
  • 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: DMITRIY GURGOV
Title or Position: PRESIDENT
Credential:
Phone: 917-470-4720