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General NPI Number Information
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NPI Number | 1578124582
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Entity Type | Organization
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Legal Business Name | ST GEORGE COMMUNITY CENTER 1, INC.
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Dates
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Enumeration Date | 06/21/2019
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 6209 11TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11219-5205
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Country | US
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Telephone | 929-305-3003
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Fax | 718-524-9421
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Provider Business Mailing Address
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Address Line | 6209 11TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11219-5205
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Country | US
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Telephone | 929-305-3003
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Fax | 718-524-9421
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Authorized Official
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Title or Position | DIRECTOR OF PROGRAMS
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Name | MINA KOLTA
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Credential |
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Telephone | 929-305-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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