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General NPI Number Information
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NPI Number | 1871167262
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Entity Type | Organization
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Legal Business Name | 117 SADC INC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 213 E 117TH ST
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City | NEW YORK
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State | NY
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Zip | 10035-4814
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Country | US
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Telephone | 347-348-8790
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Fax |
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Provider Business Mailing Address
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Address Line | 213 E 117TH ST
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City | NEW YORK
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State | NY
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Zip | 10035-4814
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Country | US
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Telephone | 347-348-8790
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER (CEO)
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Name | HANNAH K HONG
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Credential |
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Telephone | 347-348-8790
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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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