Healthcare Provider Details

I. General information

NPI: 1114761129
Provider Name (Legal Business Name): VICTORY BLVD SOCIAL DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 VICTORY BLVD
STATEN ISLAND NY
10314-3553
US

IV. Provider business mailing address

1975 VICTORY BLVD
STATEN ISLAND NY
10314-3553
US

V. Phone/Fax

Practice location:
  • Phone: 646-515-6898
  • Fax:
Mailing address:
  • Phone: 646-515-6898
  • 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: LINA CHEN
Title or Position: PRESIDENT
Credential:
Phone: 646-515-6898