Provider Demographics
NPI:1811528847
Name:ALL STARS ADULT SOCIAL CENTER CORP
Entity type:Organization
Organization Name:ALL STARS ADULT SOCIAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:BERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-245-9163
Mailing Address - Street 1:11024 SUTPHIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5716
Mailing Address - Country:US
Mailing Address - Phone:917-213-4846
Mailing Address - Fax:
Practice Address - Street 1:11024 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5716
Practice Address - Country:US
Practice Address - Phone:917-213-4846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care