=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730652470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AM SOCIAL ADULT DAYCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2019
-----------------------------------------------------
Last Update Date | 01/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4128 HAIGHT ST STE C1
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-4274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-771-5698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4128 HAIGHT ST STE C1
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-4274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YAN JIN ZHANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-771-5698
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------