MEDICARE: DAVIS SOCIAL ADULT SERVICES

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	251300000X	Local Education Agency (LEA)	1865	NY
2	251B00000X	Case Management Agency		NY
3	253Z00000X	In Home Supportive Care Agency		NY
4	347C00000X	Private Vehicle		NY
5	261QA0600X	Adult Day Care Clinic/Center		NY

General Provider Information

NPI Number	:	1639552045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS SOCIAL ADULT SERVICES

Provider Business Mailing Address
First Line	:	1349 BROADWAY FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3618
Country	:	US
Telephone Number	:	718-455-3600
Fax Number	:	718-455-3601

Provider Business Practice Location Address
First Line	:	1349 BROADWAY FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3618
Country	:	US
Telephone Number	:	718-455-3600
Fax Number	:	718-455-3601

Authorized Official
Title or Position	:	CEO/ DIRECTOR
Name	:	MR. STEPHEN EDWARD DAVIS III
Credential	:
Telephone Number	:	718-455-3600

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	07/02/2015

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