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General NPI Number Information
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NPI Number | 1710641865
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Entity Type | Organization
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Legal Business Name | WONDERFUL SENIOR PROGRAM INC.
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 13419 BLOSSOM AVE FL 1
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City | FLUSHING
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State | NY
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Zip | 11355-4893
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Country | US
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Telephone | 929-202-3377
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Fax | 347-246-0478
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Provider Business Mailing Address
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Address Line | 13419 BLOSSOM AVE
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City | FLUSHING
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State | NY
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Zip | 11355-4893
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Country | US
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Telephone | 929-202-3377
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Fax | 347-246-0478
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Authorized Official
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Title or Position | OWNER
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Name | ZHONG REN LIU
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Credential |
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Telephone | 929-202-3377
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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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