Crystal Lake Senior Daycare, Inc.

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

CRYSTAL LAKE SENIOR DAYCARE, INC.

Practice address

4317 Union St Ste a
Flushing, NY 11355-3460

Phone

(646) 707-5808

NPI assigned

Feb 29, 2024

Last updated

Feb 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dan Chen

Title

Manager

Phone

(646) 707-5808

Specialties & licenses 1

Addresses

Tax ID family

Crystal Lake Senior Daycare Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Crystal Lake Senior Daycare, Inc.

  • Adult Day Care Clinic/Center
  • Brooklyn, NY
  • NPI 1154186542
  NPD tax ID
• Crystal Lake Senior Daycare, Inc.

  • Adult Day Care Clinic/Center
  • Brooklyn, NY
  • NPI 1992542724
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1427815190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4317 UNION ST STE A",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113553460",
            "telephone_number": "646-707-5808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4317 UNION ST STE A",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113553460",
            "telephone_number": "646-707-5808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE SENIOR DAYCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "646-707-5808"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evelyn Patricia Cruz, MSW
• Florencia Santos Cruz, MD
• Jessica Cruz, LMSW
• Maria Ramirez Cruz
• Zachary Cruz, LMHC, CASAC-T
• Dante Acebo Cubangbang, M.D.
• Ann-Marie Cucinotta
• Jian Cui, M.D.
• Peng Cui, L.AC
• Shugui Cui

• Adult Day Care Clinic/Center in Flushing, NY
• Providers in Flushing, NY by specialty
• Adult Day Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.