Healthcare Provider Details

I. General information

NPI: 1235717083
Provider Name (Legal Business Name): 2ND HOME ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 FLETCHER DR
LOS ANGELES CA
90065-2919
US

IV. Provider business mailing address

3225 FLETCHER DR
LOS ANGELES CA
90065-2919
US

V. Phone/Fax

Practice location:
  • Phone: 707-500-8000
  • Fax:
Mailing address:
  • Phone: 707-500-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARYAM GHUKASIAN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 626-731-4990