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General NPI Number Information
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NPI Number | 1275163792
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Entity Type | Organization
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Legal Business Name | MOUNT VERNON ADULT CENTER LLC
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 22 E 1ST ST
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City | MOUNT VERNON
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State | NY
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Zip | 10550-3301
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Country | US
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Telephone | 718-456-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 11915 27TH AVE
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City | FLUSHING
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State | NY
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Zip | 11354-1011
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Country | US
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Telephone | 718-461-5000
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Fax |
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Authorized Official
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Title or Position | OPERATOR
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Name | MR. MICHAEL BERGER
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Credential |
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Telephone | 917-969-1208
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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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