Provider Demographics
NPI:1639552045
Name:DAVIS SOCIAL ADULT SERVICES
Entity Type:Organization
Organization Name:DAVIS SOCIAL ADULT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:718-455-3600
Mailing Address - Street 1:1349 BROADWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3618
Mailing Address - Country:US
Mailing Address - Phone:718-455-3600
Mailing Address - Fax:718-455-3601
Practice Address - Street 1:1349 BROADWAY FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3618
Practice Address - Country:US
Practice Address - Phone:718-455-3600
Practice Address - Fax:718-455-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1865251300000X
NY251B00000X, 253Z00000X, 261QA0600X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle