MEDICARE: DORSETTE MAPP ADULT DAY PROGRAM

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609399005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORSETTE MAPP ADULT DAY PROGRAM

Provider Business Mailing Address
First Line	:	701 RUTLAND RD.
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-1807
Country	:	US
Telephone Number	:	347-693-0193
Fax Number	:

Provider Business Practice Location Address
First Line	:	376 DECATUR ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-1508
Country	:	US
Telephone Number	:	718-756-1108
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DORSETTE MAPP
Credential	:
Telephone Number	:	347-693-0193

Provider Enumeration Date	:	07/18/2017
Last Update Date	:	07/18/2017

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