Provider Demographics
NPI:1457002909
Name:GRACE ADULT DAYCARE-MULTISERVICE LLC
Entity Type:Organization
Organization Name:GRACE ADULT DAYCARE-MULTISERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MACKENSDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORMEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-392-6930
Mailing Address - Street 1:PO BOX 110614
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-0614
Mailing Address - Country:US
Mailing Address - Phone:917-392-6930
Mailing Address - Fax:
Practice Address - Street 1:19011 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3346
Practice Address - Country:US
Practice Address - Phone:929-433-0054
Practice Address - Fax:929-433-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care