Provider Demographics
NPI:1952641128
Name:BOULEVARD ADULT DAY CARE OF FLUSHING
Entity Type:Organization
Organization Name:BOULEVARD ADULT DAY CARE OF FLUSHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-380-8882
Mailing Address - Street 1:15813 72ND AVE
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1140
Mailing Address - Country:US
Mailing Address - Phone:718-380-8882
Mailing Address - Fax:
Practice Address - Street 1:4234 SAULL ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4543
Practice Address - Country:US
Practice Address - Phone:718-473-3929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home