Healthcare Provider Details

I. General information

NPI: 1104976612
Provider Name (Legal Business Name): FAMILY ADULT DAY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 LOMITA BLVD
LOMITA CA
90717-1436
US

IV. Provider business mailing address

2280 LOMITA BLVD
LOMITA CA
90717-1436
US

V. Phone/Fax

Practice location:
  • Phone: 310-602-0123
  • Fax: 310-602-0124
Mailing address:
  • Phone: 310-602-0123
  • Fax: 310-602-0124

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: MS. JOSEPHINE CHAVEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-602-0123