MEDICARE: LY EAST FLUSHING ADULT CARE 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	:	1760746119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LY EAST FLUSHING ADULT CARE INC

Provider Business Mailing Address
First Line	:	4519 162ND ST STE 1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-3137
Country	:	US
Telephone Number	:	718-801-7833
Fax Number	:

Provider Business Practice Location Address
First Line	:	4519 162ND ST STE 1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-3137
Country	:	US
Telephone Number	:	718-801-7833
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. XIAO PING ZHANG
Credential	:	R.N.
Telephone Number	:	718-801-7833

Provider Enumeration Date	:	06/30/2012
Last Update Date	:	06/30/2012

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