=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053868273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN SENIOR CARE CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2016
-----------------------------------------------------
Last Update Date | 09/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6813 20TH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-513-6825
-----------------------------------------------------
Fax | 929-399-7819
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6813 20TH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-513-6825
-----------------------------------------------------
Fax | 929-399-7819
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. YUAN ZHEN LI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-513-6825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------