Healthcare Provider Details

I. General information

NPI: 1326559782
Provider Name (Legal Business Name): MOLLISON ADULT DAY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S MOLLISON AVE
EL CAJON CA
92020-4814
US

IV. Provider business mailing address

8744 GOLF DR
SPRING VALLEY CA
91977-1009
US

V. Phone/Fax

Practice location:
  • Phone: 619-551-2133
  • Fax:
Mailing address:
  • Phone: 248-819-1422
  • Fax: 619-303-7876

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: MRS. LOALOA N KARANA SHAMOUN
Title or Position: MANAGER
Credential: CEO
Phone: 619-551-2133