Healthcare Provider Details

I. General information

NPI: 1689870024
Provider Name (Legal Business Name): LANCASTER ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 W. JACKMAN SUITE #101
LANCASTER CA
93534
US

IV. Provider business mailing address

45104 10TH STREET WEST
LANCASTER CA
93534
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-1228
  • Fax: 661-948-8109
Mailing address:
  • Phone: 661-942-2391
  • Fax: 661-902-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000691
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES A COOK
Title or Position: C.E.O.
Credential:
Phone: 661-942-2391