Healthcare Provider Details

I. General information

NPI: 1336576180
Provider Name (Legal Business Name): ON LOK SENIOR HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3683 PERALTA BLVD
FREMONT CA
94536-3708
US

IV. Provider business mailing address

1333 BUSH ST
SAN FRANCISCO CA
94109-5611
US

V. Phone/Fax

Practice location:
  • Phone: 510-494-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number550001891
License Number StateCA

VIII. Authorized Official

Name: GRACE LI HARPER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 415-292-8883