Healthcare Provider Details

I. General information

NPI: 1154763324
Provider Name (Legal Business Name): GEORGETOWN ADULT SOCIAL DAYCARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 LIBERTY AVE
SOUTH RICHMOND HILL NY
11419-2117
US

IV. Provider business mailing address

12021 LIBERTY AVE
SOUTH RICHMOND HILL NY
11419-2117
US

V. Phone/Fax

Practice location:
  • Phone: 347-975-2525
  • 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: CHRISTINE PERSAUD
Title or Position: MANAGER
Credential:
Phone: 347-975-2525