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General NPI Number Information
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NPI Number | 1952641128
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Entity Type | Organization
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Legal Business Name | BOULEVARD ADULT DAY CARE OF FLUSHING
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 4234 SAULL ST
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City | FLUSHING
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State | NY
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Zip | 11355-4543
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Country | US
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Telephone | 718-473-3929
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Fax |
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Provider Business Mailing Address
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Address Line | 15813 72ND AVE SUITE 2F
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City | FLUSHING
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State | NY
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Zip | 11365-1140
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Country | US
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Telephone | 718-380-8882
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. DAVID MARX
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Credential |
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Telephone | 718-380-8882
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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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