MEDICARE: 4EVER GOOD ADULT DAYCARE 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	:	1942859053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4EVER GOOD ADULT DAYCARE CENTER INC

Provider Business Mailing Address
First Line	:	2980 RICHMOND TER
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-2318
Country	:	US
Telephone Number	:	718-524-4064
Fax Number	:

Provider Business Practice Location Address
First Line	:	2980 RICHMOND TER
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-2318
Country	:	US
Telephone Number	:	718-524-4064
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RODNEY LEE
Credential	:
Telephone Number	:	718-524-4064

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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