Healthcare Provider Details

I. General information

NPI: 1295162147
Provider Name (Legal Business Name): ELITE SOCIAL ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2013
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 EXECUTIVE BLVD
VALLEY COTTAGE NY
10989-2038
US

IV. Provider business mailing address

110 ROCKAWAY TPKE SUITE 4
LAWRENCE NY
11559-1626
US

V. Phone/Fax

Practice location:
  • Phone: 718-338-6302
  • Fax:
Mailing address:
  • Phone:
  • 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: YITZCHAK CWEIBER
Title or Position: MANAGING MEMBER
Credential:
Phone: 718-338-6302