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General NPI Number Information
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NPI Number | 1609118694
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Entity Type | Organization
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Legal Business Name | JEZLIAH ADULT SOCIAL DAYCARE
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 501 JEFFERSON AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-3311
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Country | US
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Telephone | 516-678-0728
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Fax | 516-678-0728
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Provider Business Mailing Address
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Address Line | 501 JEFFERSON AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-3311
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Country | US
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Telephone | 516-678-0728
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Fax | 516-678-0728
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Authorized Official
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Title or Position | OWNER
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Name | FAITH C HUTCHINSON
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Credential |
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Telephone | 516-678-0728
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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 | 400Q268
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License Number State | NY
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