Healthcare Provider Details

I. General information

NPI: 1750362091
Provider Name (Legal Business Name): COMMUNITY ADULT DAY HEALTH CARE CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 ATLANTIC AVE
LONG BEACH CA
90806-5510
US

IV. Provider business mailing address

1954 ATLANTIC AVE
LONG BEACH CA
90806-5510
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-7753
  • Fax: 562-591-1422
Mailing address:
  • Phone: 562-591-7753
  • Fax: 562-591-1422

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. JOSEPH JACKSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-591-7753