Provider Demographics
NPI:1063786408
Name:LY ADULT CARE CENTER INC
Entity type:Organization
Organization Name:LY ADULT CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:XIAO
Authorized Official - Middle Name:PING
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-801-7833
Mailing Address - Street 1:361 BAY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5314
Mailing Address - Country:US
Mailing Address - Phone:718-801-7833
Mailing Address - Fax:
Practice Address - Street 1:14232 38TH AVE # 2F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5526
Practice Address - Country:US
Practice Address - Phone:718-801-7833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care