Provider Demographics
NPI:1578808895
Name:EVERGREEN ADULT DAY CARE IN FLUSHING INC
Entity Type:Organization
Organization Name:EVERGREEN ADULT DAY CARE IN FLUSHING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-820-6911
Mailing Address - Street 1:3710 149TH PL # 1A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4918
Mailing Address - Country:US
Mailing Address - Phone:718-820-6911
Mailing Address - Fax:718-359-6024
Practice Address - Street 1:3710 149TH PL # 1A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4918
Practice Address - Country:US
Practice Address - Phone:718-820-6911
Practice Address - Fax:718-359-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care