Provider Demographics
NPI:1417723529
Name:CORONA COMMUNITY SENIOR CENTER INC.
Entity Type:Organization
Organization Name:CORONA COMMUNITY SENIOR CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JINLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-575-0958
Mailing Address - Street 1:5515 VAN CLEEF ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3907
Mailing Address - Country:US
Mailing Address - Phone:929-575-0958
Mailing Address - Fax:
Practice Address - Street 1:10802 OTIS AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3914
Practice Address - Country:US
Practice Address - Phone:929-575-0958
Practice Address - Fax:718-271-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness