Healthcare Provider Details

I. General information

NPI: 1487864468
Provider Name (Legal Business Name): INGLEWOOD COMMUNITY ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 M. MAGNOLIA AVE
EL CAJON CA
92020
US

IV. Provider business mailing address

490 M. MAGNOLIA AVE
EL CAJON CA
92020
US

V. Phone/Fax

Practice location:
  • Phone: 619-444-1522
  • Fax: 619-444-1516
Mailing address:
  • Phone: 619-444-1522
  • Fax: 619-444-1516

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: NATALY KOURABI
Title or Position: OWNER/CEO
Credential:
Phone: 310-266-6494