Healthcare Provider Details

I. General information

NPI: 1396403267
Provider Name (Legal Business Name): EASTVALE ADHC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12442 LIMONITE AVE STE A100
EASTVALE CA
91752-2467
US

IV. Provider business mailing address

12442 LIMONITE AVE STE A100
EASTVALE CA
91752-2467
US

V. Phone/Fax

Practice location:
  • Phone: 626-945-8801
  • Fax:
Mailing address:
  • Phone: 626-945-8801
  • 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: MR. WILLIAM WENG
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-945-8801