Healthcare Provider Details

I. General information

NPI: 1972840775
Provider Name (Legal Business Name): GOLDEN YEARS ADCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 CANAL ST FL 1
STATEN ISLAND NY
10304-2273
US

IV. Provider business mailing address

135 CANAL STREET
STATEN ISLAND NY
10304
US

V. Phone/Fax

Practice location:
  • Phone: 718-815-1101
  • Fax: 718-815-1075
Mailing address:
  • Phone: 718-815-1101
  • 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: RAISA SHINDER
Title or Position: OWNER
Credential:
Phone: 718-815-1101