Provider Demographics
NPI:1114474160
Name:FAIRVIEW ADULT DAY CARE CENTER
Entity Type:Organization
Organization Name:FAIRVIEW ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RAHCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-263-4600
Mailing Address - Street 1:1440 E 99TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5523
Mailing Address - Country:US
Mailing Address - Phone:718-263-4600
Mailing Address - Fax:718-263-8947
Practice Address - Street 1:1444 E 99TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5523
Practice Address - Country:US
Practice Address - Phone:718-263-4600
Practice Address - Fax:718-263-8947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRVIEW NURSING CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-07
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003375N311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1194733642Medicaid