Provider Demographics
NPI:1164766770
Name:WONDERFUL LIFE ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:WONDERFUL LIFE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEYLIKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-234-3666
Mailing Address - Street 1:2034 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-3163
Mailing Address - Country:US
Mailing Address - Phone:929-234-3666
Mailing Address - Fax:929-234-3664
Practice Address - Street 1:2034 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-3163
Practice Address - Country:US
Practice Address - Phone:929-234-3666
Practice Address - Fax:929-234-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care