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General NPI Number Information
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NPI Number | 1992542724
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Entity Type | Organization
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Legal Business Name | CRYSTAL LAKE SENIOR DAYCARE, INC.
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Dates
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Enumeration Date | 07/10/2024
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 900 60TH ST
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City | BROOKLYN
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State | NY
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Zip | 11219-4829
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Country | US
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Telephone | 718-500-4781
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Fax |
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Provider Business Mailing Address
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Address Line | 900 60TH ST
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City | BROOKLYN
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State | NY
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Zip | 11219-4829
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Country | US
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Telephone | 718-500-4780
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Fax | 718-500-4841
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Authorized Official
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Title or Position | PRESIDENT
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Name | LI CHEN
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Credential |
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Telephone | 917-529-2415
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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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