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General NPI Number Information
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NPI Number | 1902355431
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Entity Type | Organization
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Legal Business Name | LIVINGWELL DAY CARE CENTER LLC
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 13781 NORTHERN BLVD
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City | FLUSHING
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State | NY
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Zip | 11354-4320
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Country | US
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Telephone | 929-362-2477
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Fax | 929-362-2451
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Provider Business Mailing Address
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Address Line | 13781 NORTHERN BLVD
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City | FLUSHING
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State | NY
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Zip | 11354-4320
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Country | US
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Telephone | 929-362-2477
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Fax | 929-362-2451
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JIEMIN SHANG
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Credential |
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Telephone | 347-395-7768
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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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