MEDICARE: SI ADULT DAY CARE 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	:	1518520857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SI ADULT DAY CARE 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1725
Country	:	US
Telephone Number	:	718-227-8266
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YANG OUM
Credential	:
Telephone Number	:	718-227-8266

Provider Enumeration Date	:	04/22/2019
Last Update Date	:	04/22/2019

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