Provider Demographics
NPI:1013323179
Name:UNION SETTLEMENT ASSOCIATION ADULT DAYCARE
Entity Type:Organization
Organization Name:UNION SETTLEMENT ASSOCIATION ADULT DAYCARE
Other - Org Name:JOHNSON WELDON JOHNSON COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-828-6034
Mailing Address - Street 1:237 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5404
Mailing Address - Country:US
Mailing Address - Phone:212-828-6034
Mailing Address - Fax:212-828-6047
Practice Address - Street 1:402 E 105TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5010
Practice Address - Country:US
Practice Address - Phone:212-828-6034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION SETTLEMENT ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00734854Medicaid