Basic Information
| Provider Information | |||||||||
| NPI: | 1811390008 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRYSTAL RUN DAYCARE CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2115 SURF AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112242108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187303008 | ||||||||
| FaxNumber: | 7189754337 | ||||||||
| Practice Location | |||||||||
| Address1: | 2912 BRIGHTON 12TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112354754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189754334 | ||||||||
| FaxNumber: | 7189754337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2014 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | LESHCHINSKY | ||||||||
| AuthorizedOfficialFirstName: | LIDIYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7187303008 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No ID Information.