Healthcare Provider Details

I. General information

NPI: 1508043803
Provider Name (Legal Business Name): JWBJW-ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 PACIFIC AVE
LONG BEACH CA
90806-3025
US

IV. Provider business mailing address

2385 PACIFIC AVE
LONG BEACH CA
90806-3025
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-7772
  • Fax:
Mailing address:
  • Phone: 562-426-7772
  • 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: SHEILAH GRIER
Title or Position: DIRECTOR OF PATIENT ACCOUNTING
Credential:
Phone: 562-426-7772