Provider Demographics
NPI:1083120604
Name:ZAMZAM SOCIAL ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:ZAMZAM SOCIAL ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:NA
Authorized Official - Phone:347-658-9750
Mailing Address - Street 1:15015 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3319
Mailing Address - Country:US
Mailing Address - Phone:347-658-9750
Mailing Address - Fax:
Practice Address - Street 1:15015 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3319
Practice Address - Country:US
Practice Address - Phone:347-658-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care