Healthcare Provider Details

I. General information

NPI: 1295944155
Provider Name (Legal Business Name): SOUTH COUNTY SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24300 EL TORO RD BLDG. A
LAGUNA WOODS CA
92637-2737
US

IV. Provider business mailing address

24300 EL TORO RD BLDG. A
LAGUNA WOODS CA
92637-2737
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-9444
  • Fax: 949-855-4093
Mailing address:
  • Phone: 949-855-9444
  • Fax: 949-855-4093

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: MR. JACK WALTER LIGHT
Title or Position: PROGRAM DIRECTOR
Credential: LCSW
Phone: 949-855-9444