Healthcare Provider Details

I. General information

NPI: 1285859249
Provider Name (Legal Business Name): KINGSLEY PLACE ADULT HEALTH DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 S KINGSLEY DR
LOS ANGELES CA
90020-3506
US

IV. Provider business mailing address

548 S KINGSLEY DR
LOS ANGELES CA
90020-3506
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-3303
  • Fax: 213-384-1772
Mailing address:
  • Phone: 213-383-3303
  • Fax: 213-384-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000786
License Number StateCA

VIII. Authorized Official

Name: CRYSTAL PAK
Title or Position: CEO
Credential:
Phone: 213-383-3303