Healthcare Provider Details

I. General information

NPI: 1922782192
Provider Name (Legal Business Name): LIFE LONG SENIOR DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BUSTLETON AVE
PHILADELPHIA PA
19115-3810
US

IV. Provider business mailing address

9601B BUSTLETON AVE
PHILADELPHIA PA
19115-3810
US

V. Phone/Fax

Practice location:
  • Phone: 917-856-9488
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DANIEL YONG
Title or Position: ADMINISTRATOR
Credential:
Phone: 917-856-9488