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General NPI Number Information
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NPI Number | 1811528847
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Entity Type | Organization
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Legal Business Name | ALL STARS ADULT SOCIAL CENTER CORP
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 11024 SUTPHIN BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-5716
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Country | US
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Telephone | 917-213-4846
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Fax |
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Provider Business Mailing Address
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Address Line | 11024 SUTPHIN BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-5716
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Country | US
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Telephone | 917-213-4846
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. BRIDGET BERAN
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Credential |
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Telephone | 347-245-9163
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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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