Provider Demographics
NPI:1992121263
Name:ROCKAWAY ADULT SOCIAL CENTER
Entity type:Organization
Organization Name:ROCKAWAY ADULT SOCIAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-926-4134
Mailing Address - Street 1:1858 CORNAGA AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4304
Mailing Address - Country:US
Mailing Address - Phone:347-926-4134
Mailing Address - Fax:
Practice Address - Street 1:1858 CORNAGA AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4304
Practice Address - Country:US
Practice Address - Phone:347-926-4134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care