Provider Demographics
NPI:1609118694
Name:JEZLIAH ADULT SOCIAL DAYCARE
Entity Type:Organization
Organization Name:JEZLIAH ADULT SOCIAL DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-678-0728
Mailing Address - Street 1:501 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3311
Mailing Address - Country:US
Mailing Address - Phone:516-678-0728
Mailing Address - Fax:516-678-0728
Practice Address - Street 1:501 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3311
Practice Address - Country:US
Practice Address - Phone:516-678-0728
Practice Address - Fax:516-678-0728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEZLIAH FAMILY TYPE HOME FOR ADULTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400Q268311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home