Healthcare Provider Details

I. General information

NPI: 1760723621
Provider Name (Legal Business Name): SI. SENIOR LIFESTYLE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 PORT RICHMOND AVE
STATEN ISLAND NY
10302
US

IV. Provider business mailing address

98 PORT RICHMOND AVE
STATEN ISLAND NY
10302
US

V. Phone/Fax

Practice location:
  • Phone: 718-273-6200
  • Fax:
Mailing address:
  • Phone: 718-273-6200
  • 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: MS. JOYCE CEN
Title or Position: PRESIDENT
Credential:
Phone: 718-273-6200