Healthcare Provider Details

I. General information

NPI: 1932931680
Provider Name (Legal Business Name): LINCOLN ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 23RD ST
WATERVLIET NY
12189-2128
US

IV. Provider business mailing address

410 23RD ST
WATERVLIET NY
12189-2128
US

V. Phone/Fax

Practice location:
  • Phone: 714-335-0142
  • Fax: 518-677-1004
Mailing address:
  • Phone: 714-335-0142
  • 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: SUNG JUN KIM
Title or Position: CEO/ DIRECTOR
Credential:
Phone: 714-335-0142