MEDICARE: LUCKY SOCIAL ADULT DAY SERVICE

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	:	1801373543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCKY SOCIAL ADULT DAY SERVICE

Provider Business Mailing Address
First Line	:	6506 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6506 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3931
Country	:	US
Telephone Number	:	718-676-9708
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JIN YUAN YU
Credential	:
Telephone Number	:	718-676-9708

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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