Provider Demographics
NPI:1003318312
Name:CRYSTAL ADULT SOCIAL DAY CARE LLC
Entity type:Organization
Organization Name:CRYSTAL ADULT SOCIAL DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-674-5788
Mailing Address - Street 1:13831 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2641
Mailing Address - Country:US
Mailing Address - Phone:718-642-0011
Mailing Address - Fax:718-558-9290
Practice Address - Street 1:138-31 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:718-642-0011
Practice Address - Fax:718-558-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care