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General NPI Number Information
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NPI Number | 1225483555
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Entity Type | Organization
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Legal Business Name | GRACEVILLE ADULT DAY CARE CENTER INC.
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Dates
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Enumeration Date | 04/23/2016
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Last Update Date | 04/23/2016
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Provider Practice Location Address
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Address Line | 1415 CLINTONVILLE ST
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City | WHITESTONE
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State | NY
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Zip | 11357-1825
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Country | US
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Telephone | 516-606-3856
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Fax |
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Provider Business Mailing Address
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Address Line | 9 WINTHROP DR
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City | WOODBURY
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State | NY
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Zip | 11797-1318
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Country | US
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Telephone | 516-606-3856
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. TERESA YEE WA WU
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Credential | L.AC
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Telephone | 516-606-3856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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