Provider Demographics
NPI:1003553843
Name:EVERGREEN SENIOR DAYCARE CENTER INC
Entity Type:Organization
Organization Name:EVERGREEN SENIOR DAYCARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTION
Authorized Official - Prefix:
Authorized Official - First Name:WEI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-288-9878
Mailing Address - Street 1:14222 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14222 37TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4103
Practice Address - Country:US
Practice Address - Phone:718-799-0423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERGREEN SENIOR DAYCARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care