Organization
ELMCOR YOUTH & ADULT ACTIVITIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LIANNA LEE (ACTING EXECUTIVE DIRECTOR)
(718) 651-0096
Entity
Organization
Contact information
Practice address
10720 NORTHERN BLVD, CORONA, NY 11368-1236
(718) 651-0096
(718) 457-3932
Mailing address
3316 108TH ST, CORONA, NY 11368-1224
(718) 651-0096
(718) 457-3932
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02772338
—
NY
Enumeration date
03/14/2007
Last updated
08/22/2020
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