Provider Demographics
NPI:1225335516
Name:ATLANTIC ADULT DAY CARE CENTER, INC
Entity Type:Organization
Organization Name:ATLANTIC ADULT DAY CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSEPENYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-755-3733
Mailing Address - Street 1:823 65TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4737
Mailing Address - Country:US
Mailing Address - Phone:347-479-5690
Mailing Address - Fax:347-560-6574
Practice Address - Street 1:823 65TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4737
Practice Address - Country:US
Practice Address - Phone:347-479-5690
Practice Address - Fax:347-560-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care