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General NPI Number Information
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NPI Number | 1164766770
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Entity Type | Organization
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Legal Business Name | WONDERFUL LIFE ADULT DAY CARE LLC
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 2034 ATLANTIC AVE
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City | BROOKLYN
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State | NY
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Zip | 11233-3163
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Country | US
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Telephone | 929-234-3666
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Fax | 929-234-3664
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Provider Business Mailing Address
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Address Line | 2034 ATLANTIC AVE
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City | BROOKLYN
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State | NY
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Zip | 11233-3163
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Country | US
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Telephone | 929-234-3666
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Fax | 929-234-3664
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Authorized Official
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Title or Position | PRESIDENT
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Name | IRENA ZEYLIKMAN
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Credential |
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Telephone | 929-234-3666
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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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