Provider Demographics
NPI:1689143240
Name:PRIME LIFE ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:PRIME LIFE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZHU YING
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-605-3234
Mailing Address - Street 1:7302 18TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7302 18TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5635
Practice Address - Country:US
Practice Address - Phone:347-605-3234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care