MEDICARE: RICHMOND ADULT DAY CENTER 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	:	1427441575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND ADULT DAY CENTER INC.

Provider Business Mailing Address
First Line	:	2015 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1725
Country	:	US
Telephone Number	:	347-855-3862
Fax Number	:	347-214-3712

Provider Business Practice Location Address
First Line	:	2015 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1725
Country	:	US
Telephone Number	:	347-855-3862
Fax Number	:	347-214-3712

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	YVONNE WARD
Credential	:
Telephone Number	:	347-855-3862

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	03/13/2015

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