Provider Demographics
NPI:1225483555
Name:GRACEVILLE ADULT DAY CARE CENTER INC.
Entity Type:Organization
Organization Name:GRACEVILLE ADULT DAY CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:YEE WA
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:516-606-3856
Mailing Address - Street 1:9 WINTHROP DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1318
Mailing Address - Country:US
Mailing Address - Phone:516-606-3856
Mailing Address - Fax:
Practice Address - Street 1:1415 CLINTONVILLE ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1825
Practice Address - Country:US
Practice Address - Phone:516-606-3856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-23
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization