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General NPI Number Information
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NPI Number | 1679072516
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Entity Type | Organization
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Legal Business Name | MINNIE MAE SOCIAL ADULT DAY CENTER LLC
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 301 S FULTON AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10553
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Country | US
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Telephone | 914-292-1064
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Fax | 914-863-2070
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Provider Business Mailing Address
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Address Line | 296 WARREN ST
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City | BROOKLYN
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State | NY
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Zip | 11201-6590
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Country | US
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Telephone | 347-556-5188
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. LISA MILLS
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Credential | LMSW, CASAC
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Telephone | 347-556-5188
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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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