Provider Demographics
NPI:1699811166
Name:DAUGHTERS OF JACOB ADULT DAY CARE PROGRAM
Entity Type:Organization
Organization Name:DAUGHTERS OF JACOB ADULT DAY CARE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:PREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-293-1500
Mailing Address - Street 1:1160 TELLER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-4145
Mailing Address - Country:US
Mailing Address - Phone:718-293-1500
Mailing Address - Fax:718-992-7074
Practice Address - Street 1:1160 TELLER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-4145
Practice Address - Country:US
Practice Address - Phone:718-293-1500
Practice Address - Fax:718-992-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000342N261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01164130Medicaid