Provider Demographics
NPI:1285198267
Name:INTEGRATED ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:INTEGRATED ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSUKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-981-9551
Mailing Address - Street 1:125 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2926
Mailing Address - Country:US
Mailing Address - Phone:917-981-9551
Mailing Address - Fax:
Practice Address - Street 1:125 N 5TH ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2926
Practice Address - Country:US
Practice Address - Phone:917-981-9551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care