Provider Demographics
NPI:1649682444
Name:EVERGREEN ADULT DAY CARE IN NEW YORK CN
Entity type:Organization
Organization Name:EVERGREEN ADULT DAY CARE IN NEW YORK CN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-621-8715
Mailing Address - Street 1:13235 41ST RD STE 1E
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13235 41ST RD STE 1E
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4354
Practice Address - Country:US
Practice Address - Phone:917-621-8715
Practice Address - Fax:917-591-8068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERGREEN ADULT DAY CARE IN NEW YORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-28
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care