Provider Demographics
NPI:1851641500
Name:EVERGREEN ADULT DAY CARE IN NY, INC
Entity type:Organization
Organization Name:EVERGREEN ADULT DAY CARE IN NY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HYUN JONG
Authorized Official - Middle Name:
Authorized Official - Last Name:ICOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-321-2112
Mailing Address - Street 1:144-74 NORTHERN BLVD
Mailing Address - Street 2:2 FL.
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-321-2112
Mailing Address - Fax:718-925-4105
Practice Address - Street 1:144-74 NORTHERN BLVD
Practice Address - Street 2:2 FL.
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-321-2112
Practice Address - Fax:718-925-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care