Healthcare Provider Details

I. General information

NPI: 1770981409
Provider Name (Legal Business Name): SILVER WILLOWS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 FARM LN
SPRING VALLEY NY
10977-1137
US

IV. Provider business mailing address

9 FARM LN
SPRING VALLEY NY
10977-1137
US

V. Phone/Fax

Practice location:
  • Phone: 267-253-4836
  • Fax:
Mailing address:
  • Phone: 267-253-4836
  • 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: MRS. ZAREMA JAGIZAROV
Title or Position: PROGRAM DIRECTOR
Credential: C.D.P.
Phone: 267-253-4836