Provider Demographics
NPI:1306192042
Name:FIESTA ADULT DAYCARE LLC
Entity type:Organization
Organization Name:FIESTA ADULT DAYCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-865-6602
Mailing Address - Street 1:76 WEST BRIGHTON AVE, SUITE 202
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224
Mailing Address - Country:US
Mailing Address - Phone:718-996-0456
Mailing Address - Fax:718-228-8999
Practice Address - Street 1:76 WEST BRIGHTON AVE, SUITE 202
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224
Practice Address - Country:US
Practice Address - Phone:718-996-0456
Practice Address - Fax:718-228-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care