Healthcare Provider Details

I. General information

NPI: 1174744510
Provider Name (Legal Business Name): EL CAMINO ADHC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15429 CRENSHAW BLVD STE D
GARDENA CA
90249-4510
US

IV. Provider business mailing address

15429 CRENSHAW BLVD STE D
GARDENA CA
90249-4510
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-7624
  • Fax:
Mailing address:
  • Phone: 310-679-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASKANAZ AKOPYAN
Title or Position: PRESIDENT
Credential:
Phone: 310-679-7624