Healthcare Provider Details

I. General information

NPI: 1093220683
Provider Name (Legal Business Name): SMILE ADULT DAY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 SOUTH ST
ARTESIA CA
90701-7039
US

IV. Provider business mailing address

12220 SOUTH ST
ARTESIA CA
90701-7039
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-1892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. JEANNIE WOODHEAD
Title or Position: OWNER
Credential:
Phone: 562-645-2192