Provider Demographics
NPI:1417205212
Name:YOUNG AT HEART ADULT DAY CENTER, LLC
Entity Type:Organization
Organization Name:YOUNG AT HEART ADULT DAY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-557-0000
Mailing Address - Street 1:810 FLUSHING AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4106
Mailing Address - Country:US
Mailing Address - Phone:718-557-0000
Mailing Address - Fax:718-705-6415
Practice Address - Street 1:810 FLUSHING AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4106
Practice Address - Country:US
Practice Address - Phone:718-557-0000
Practice Address - Fax:718-705-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care