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General NPI Number Information
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NPI Number | 1811390008
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Entity Type | Organization
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Legal Business Name | CRYSTAL RUN DAYCARE CENTER INC
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 2912 BRIGHTON 12TH ST
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City | BROOKLYN
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State | NY
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Zip | 11235-4754
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Country | US
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Telephone | 718-975-4334
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Fax | 718-975-4337
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Provider Business Mailing Address
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Address Line | 2115 SURF AVE
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City | BROOKLYN
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State | NY
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Zip | 11224-2108
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Country | US
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Telephone | 718-730-3008
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Fax | 718-975-4337
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIDIYA LESHCHINSKY
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Credential |
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Telephone | 718-730-3008
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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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