MEDICARE: WATERTOWN ADULT SOCIAL DAYCARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1205518610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERTOWN ADULT SOCIAL DAYCARE INC

Provider Business Mailing Address
First Line	:	144 EASTERN BLVD STE 2
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 EASTERN BLVD STE 2
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3126
Country	:	US
Telephone Number	:	646-241-6579
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CHUN WONG
Credential	:
Telephone Number	:	646-241-6579

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	08/04/2023

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