Provider Demographics
NPI:1922579044
Name:ROOSEVELT ADULT DAYCARE CENTER INC
Entity Type:Organization
Organization Name:ROOSEVELT ADULT DAYCARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAU
Authorized Official - Middle Name:HONG
Authorized Official - Last Name:YIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-887-8510
Mailing Address - Street 1:14456 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6253
Mailing Address - Country:US
Mailing Address - Phone:917-887-8510
Mailing Address - Fax:
Practice Address - Street 1:14456 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6253
Practice Address - Country:US
Practice Address - Phone:917-887-8510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care