Healthcare Provider Details

I. General information

NPI: 1316762198
Provider Name (Legal Business Name): EASTVALE ACADEMY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5337 HAMNER AVE UNIT 704
EASTVALE CA
91752-1041
US

IV. Provider business mailing address

5337 HAMNER AVE UNIT 704
EASTVALE CA
91752-1041
US

V. Phone/Fax

Practice location:
  • Phone: 626-617-1128
  • 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 State

VIII. Authorized Official

Name: DR. THOMAS TAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 626-617-1128