| NPI | 1962811760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERITA THOMAS MASON Administrator 718-344-3828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: FL AL12291) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2019-11-07 |