Provider Demographics
NPI:1992247076
Name:KINGSBRIDGE ADULT DAY CARE LLC
Entity type:Organization
Organization Name:KINGSBRIDGE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YITZI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-796-5000
Mailing Address - Street 1:170 W 233RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5639
Mailing Address - Country:US
Mailing Address - Phone:718-796-5000
Mailing Address - Fax:718-796-5001
Practice Address - Street 1:170 W 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5639
Practice Address - Country:US
Practice Address - Phone:718-796-5000
Practice Address - Fax:718-796-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health