Provider Demographics
NPI:1750820304
Name:HANA ADULT DAY CARE, LLC.
Entity Type:Organization
Organization Name:HANA ADULT DAY CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-285-2757
Mailing Address - Street 1:21425 42ND AVE STE 2R
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2586
Mailing Address - Country:US
Mailing Address - Phone:917-285-2757
Mailing Address - Fax:917-285-2382
Practice Address - Street 1:21425 42ND AVE STE 2R
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2586
Practice Address - Country:US
Practice Address - Phone:917-285-2757
Practice Address - Fax:917-285-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2017013023533270279Medicaid