=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295312296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUAJIRA ADULT DAY CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2021
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1776 BOSTON RD STE A
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10460-4907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-828-1549
-----------------------------------------------------
Fax | 718-828-5029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1776 BOSTON RD APT 1A
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10460-5077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-792-3785
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | BELGICA JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-792-3785
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------