Provider Demographics
NPI:1336516954
Name:BOULEVARD ADULT DAY CARE OF FLUSHING
Entity Type:Organization
Organization Name:BOULEVARD ADULT DAY CARE OF FLUSHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-380-8882
Mailing Address - Street 1:15813 72ND AVE
Mailing Address - Street 2:2F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1140
Mailing Address - Country:US
Mailing Address - Phone:718-380-8882
Mailing Address - Fax:718-380-6719
Practice Address - Street 1:15813 72ND AVE
Practice Address - Street 2:2F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-1140
Practice Address - Country:US
Practice Address - Phone:718-380-8882
Practice Address - Fax:718-380-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care