Healthcare Provider Details

I. General information

NPI: 1255940052
Provider Name (Legal Business Name): GOOD FAITH SOCIAL DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 BAY ST
STATEN ISLAND NY
10305-3901
US

IV. Provider business mailing address

1385 BAY ST
STATEN ISLAND NY
10305-3901
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-0900
  • Fax:
Mailing address:
  • Phone: 718-876-0900
  • 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: KYTH TRIEU
Title or Position: ADMINISTRATOR
Credential:
Phone: 347-302-7744