Healthcare Provider Details

I. General information

NPI: 1831632462
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA HEALTH CARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13909 1/2 AMAR RD
LA PUENTE CA
91746-3601
US

IV. Provider business mailing address

415 TENNESSEE ST SUITE U
REDLANDS CA
92373-8168
US

V. Phone/Fax

Practice location:
  • Phone: 626-814-3140
  • Fax: 626-814-3294
Mailing address:
  • Phone: 909-747-5801
  • Fax: 909-335-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000614
License Number StateCA

VIII. Authorized Official

Name: LESTER GERALD SPOELSTRA
Title or Position: OWNER - CEO
Credential:
Phone: 909-747-5801