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General NPI Number Information
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NPI Number | 1568709343
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Entity Type | Organization
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Legal Business Name | LIBERTY ADULT DAY CARE LLC
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Dates
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Enumeration Date | 01/13/2013
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Last Update Date | 01/13/2013
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Provider Practice Location Address
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Address Line | 12009 LIBERTY AVE 2ND FLOOR
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2117
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Country | US
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Telephone | 860-997-5863
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Fax |
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Provider Business Mailing Address
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Address Line | 12009 LIBERTY AVE 2ND FLOOR
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2117
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SURINDRA PRASAD
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Credential |
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Telephone | 860-997-5863
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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 | NY
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