Healthcare Provider Details

I. General information

NPI: 1932566593
Provider Name (Legal Business Name): INTERVAL SOCIAL ADULT DAY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14012 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11436-1416
US

IV. Provider business mailing address

14012 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11436-1416
US

V. Phone/Fax

Practice location:
  • Phone: 718-659-0336
  • Fax: 718-712-2632
Mailing address:
  • Phone: 718-659-0336
  • Fax: 718-712-2632

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: MRS. MAUREEN A EDWARDS
Title or Position: PRESIDENT
Credential:
Phone: 718-659-0336