Provider Demographics
NPI:1679072516
Name:MINNIE MAE SOCIAL ADULT DAY CENTER LLC
Entity Type:Organization
Organization Name:MINNIE MAE SOCIAL ADULT DAY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CASAC
Authorized Official - Phone:347-556-5188
Mailing Address - Street 1:296 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6590
Mailing Address - Country:US
Mailing Address - Phone:347-556-5188
Mailing Address - Fax:
Practice Address - Street 1:301 S FULTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553
Practice Address - Country:US
Practice Address - Phone:914-292-1064
Practice Address - Fax:914-863-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care