MEDICARE: HAPPY HAPPY AT HOME

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	311ZA0620X	Adult Care Home Facility	1176L007	NY

General Provider Information

NPI Number	:	1992081558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY HAPPY AT HOME

Provider Business Mailing Address
First Line	:	1122 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2345
Country	:	US
Telephone Number	:	718-421-5111
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SERGE DYMERETS
Credential	:
Telephone Number	:	718-421-5111

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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Directions to “HAPPY HAPPY AT HOME ” Practice Location

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