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General NPI Number Information
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NPI Number | 1134982143
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Entity Type | Organization
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Legal Business Name | CASA DE AMIGOS
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 4023A JUNCTION BLVD
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City | CORONA
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State | NY
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Zip | 11368-2123
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Country | US
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Telephone | 929-789-2760
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Fax |
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Provider Business Mailing Address
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Address Line | 14009 33RD AVE APT 2R
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City | FLUSHING
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State | NY
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Zip | 11354-3169
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Country | US
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Telephone | 929-393-3003
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ZHENG WANG
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Credential |
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Telephone | 929-393-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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