Healthcare Provider Details

I. General information

NPI: 1508095415
Provider Name (Legal Business Name): DAYLE MCINTOSH CENTER FOR THE DISABLED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13272 GARDEN GROVE BLVD
GARDEN GROVE CA
92843-2205
US

IV. Provider business mailing address

13272 GARDEN GROVE BLVD
GARDEN GROVE CA
92843-2205
US

V. Phone/Fax

Practice location:
  • Phone: 714-621-3300
  • Fax: 714-663-2094
Mailing address:
  • Phone: 714-621-3300
  • Fax: 714-663-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DOLORES KOLLMER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 714-621-3300