Provider Demographics
NPI:1669877007
Name:MAYFLOWER SENIOR CENTER
Entity type:Organization
Organization Name:MAYFLOWER SENIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSEPENYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-755-3733
Mailing Address - Street 1:111 W END AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4808
Mailing Address - Country:US
Mailing Address - Phone:718-513-6904
Mailing Address - Fax:718-513-6905
Practice Address - Street 1:111 W END AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4808
Practice Address - Country:US
Practice Address - Phone:718-513-6904
Practice Address - Fax:718-513-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home