Healthcare Provider Details

I. General information

NPI: 1568709343
Provider Name (Legal Business Name): LIBERTY ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2013
Last Update Date: 01/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12009 LIBERTY AVE 2ND FLOOR
SOUTH RICHMOND HILL NY
11419-2117
US

IV. Provider business mailing address

12009 LIBERTY AVE 2ND FLOOR
SOUTH RICHMOND HILL NY
11419-2117
US

V. Phone/Fax

Practice location:
  • Phone: 860-997-5863
  • 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 StateNY

VIII. Authorized Official

Name: SURINDRA PRASAD
Title or Position: DIRECTOR
Credential:
Phone: 860-997-5863