MEDICARE: CREATIVE ADULT DAYCARE CORP

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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1497146088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE ADULT DAYCARE CORP

Provider Business Mailing Address
First Line	:	199 LEE AVE # 925
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-8919
Country	:	US
Telephone Number	:	631-479-3382
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 NEW YORK AVE
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-4214
Country	:	US
Telephone Number	:	631-479-3382
Fax Number	:	631-479-3383

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DAVID NEUSTEIN
Credential	:
Telephone Number	:	631-479-3382

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	02/18/2015

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