Healthcare Provider Details

I. General information

NPI: 1336926302
Provider Name (Legal Business Name): APOLLO SENIOR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 E VALLEY PKWY
ESCONDIDO CA
92027-5219
US

IV. Provider business mailing address

2334 WASHINGTON AVE
REDDING CA
96001-2159
US

V. Phone/Fax

Practice location:
  • Phone: 760-622-8723
  • Fax:
Mailing address:
  • Phone: 530-242-8300
  • Fax: 530-244-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. PRATIK SHAH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 760-622-8723