Provider Demographics
NPI:1043379332
Name:PROMESA ADULT DAY HEALTH CARE
Entity type:Organization
Organization Name:PROMESA ADULT DAY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICIER
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DERIENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-649-3083
Mailing Address - Street 1:308 EAST 175TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:347-649-3083
Mailing Address - Fax:347-649-3090
Practice Address - Street 1:915 WESTCHESTER AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:347-649-3083
Practice Address - Fax:347-649-3090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMESA RESIDENTIAL HEALTHCARE FACILITY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02357688Medicaid