Healthcare Provider Details

I. General information

NPI: 1497484224
Provider Name (Legal Business Name): CARSONS ELITE GROUP ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 VISTA RDG
BURBANK CA
91504-1929
US

IV. Provider business mailing address

1132 VISTA RDG
BURBANK CA
91504-1929
US

V. Phone/Fax

Practice location:
  • Phone: 619-414-4530
  • Fax:
Mailing address:
  • Phone: 619-414-4530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CYNTHIA SUNDBERG
Title or Position: CONSULTANT
Credential: MHCA
Phone: 619-414-4530