Provider Demographics
NPI:1770925463
Name:OMOLARA SENIOR CARE
Entity type:Organization
Organization Name:OMOLARA SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALOME
Authorized Official - Middle Name:BERNADETTE
Authorized Official - Last Name:KING-AFUAPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-949-0048
Mailing Address - Street 1:11114 225TH ST
Mailing Address - Street 2:QUEEN VILLAGE
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2807
Mailing Address - Country:US
Mailing Address - Phone:347-251-1799
Mailing Address - Fax:718-949-0048
Practice Address - Street 1:11836 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2102
Practice Address - Country:US
Practice Address - Phone:347-251-1799
Practice Address - Fax:718-949-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care