Healthcare Provider Details

I. General information

NPI: 1992993661
Provider Name (Legal Business Name): CARSON ADULT DAY HEALTH CARE CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E CARSON PLAZA DR SUITE 105
CARSON CA
90746-3247
US

IV. Provider business mailing address

PO BOX 11067
CARSON CA
90749-1067
US

V. Phone/Fax

Practice location:
  • Phone: 310-354-0031
  • Fax: 310-354-3939
Mailing address:
  • Phone: 310-354-0031
  • Fax: 310-354-3939

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. EMMA FAJARDO CASTANEDA
Title or Position: PROGRAM DIRECTOR
Credential: R.N
Phone: 310-354-0078