Provider Demographics
NPI:1023574746
Name:BETWEEN AGES ADULT SOCIAL CENTER
Entity Type:Organization
Organization Name:BETWEEN AGES ADULT SOCIAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MCKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-223-0553
Mailing Address - Street 1:175 MEMORIAL HWY STE 1-3
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5639
Mailing Address - Country:US
Mailing Address - Phone:914-740-5160
Mailing Address - Fax:914-740-5161
Practice Address - Street 1:175 MEMORIAL HWY STE 1-3
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5639
Practice Address - Country:US
Practice Address - Phone:914-740-5160
Practice Address - Fax:914-740-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care