Provider Demographics
NPI:1609399005
Name:DORSETTE MAPP ADULT DAY PROGRAM
Entity Type:Organization
Organization Name:DORSETTE MAPP ADULT DAY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-693-0193
Mailing Address - Street 1:701 RUTLAND RD.
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1807
Mailing Address - Country:US
Mailing Address - Phone:347-693-0193
Mailing Address - Fax:
Practice Address - Street 1:376 DECATUR ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1508
Practice Address - Country:US
Practice Address - Phone:718-756-1108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0000000000000Medicaid