Provider Demographics
NPI:1932566593
Name:INTERVAL SOCIAL ADULT DAY CARE INC.
Entity Type:Organization
Organization Name:INTERVAL SOCIAL ADULT DAY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-659-0336
Mailing Address - Street 1:14012 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1416
Mailing Address - Country:US
Mailing Address - Phone:718-659-0336
Mailing Address - Fax:718-712-2632
Practice Address - Street 1:14012 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11436-1416
Practice Address - Country:US
Practice Address - Phone:718-659-0336
Practice Address - Fax:718-712-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care