Provider Demographics
NPI:1902352610
Name:ST GEORGE AULT DAY CARE CENTER INC
Entity Type:Organization
Organization Name:ST GEORGE AULT DAY CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIEST
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:YANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-519-8741
Mailing Address - Street 1:6209 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6209 11TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:917-519-8741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care