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General NPI Number Information
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NPI Number | 1346114352
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Entity Type | Organization
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Legal Business Name | EVERGREEN ADULT DAY CARE IN NY, INC
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 15012 ROOSEVELT AVE
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City | FLUSHING
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State | NY
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Zip | 11354-4936
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Country | US
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Telephone | 917-563-1214
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Fax | 917-563-1187
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Provider Business Mailing Address
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Address Line | 15012 ROOSEVELT AVE
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City | FLUSHING
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State | NY
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Zip | 11354-4936
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Country | US
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Telephone | 917-563-1214
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Fax | 917-563-1187
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | SO MI SHIN
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Credential |
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Telephone | 917-941-4844
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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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