Healthcare Provider Details

I. General information

NPI: 1407950702
Provider Name (Legal Business Name): ROBERTSON ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 S ROBERTSON BLVD
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

369 S ROBERTSON BLVD
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-7711
  • Fax: 310-289-7367
Mailing address:
  • Phone: 310-289-7711
  • Fax: 310-289-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADU70161F
License Number StateCA

VIII. Authorized Official

Name: ELEONORA GORDLIK
Title or Position: PROGRAM DIRECTOR
Credential: MSW
Phone: 310-289-7711