Provider Demographics
NPI:1376975664
Name:CORONA ADULT DAYCARE
Entity Type:Organization
Organization Name:CORONA ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NAT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-562-8317
Mailing Address - Street 1:10717 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1235
Mailing Address - Country:US
Mailing Address - Phone:917-567-0235
Mailing Address - Fax:
Practice Address - Street 1:10717 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1235
Practice Address - Country:US
Practice Address - Phone:917-567-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care