Healthcare Provider Details

I. General information

NPI: 1306047097
Provider Name (Legal Business Name): BEVERLY ADULT DAY HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N WESTERN AVE
LOS ANGELES CA
90004-2615
US

IV. Provider business mailing address

316 N WESTERN AVE
LOS ANGELES CA
90004-2615
US

V. Phone/Fax

Practice location:
  • Phone: 323-957-9777
  • Fax: 323-957-9741
Mailing address:
  • Phone: 323-957-9777
  • Fax: 323-957-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000905
License Number StateCA

VIII. Authorized Official

Name: MRS. IN JA LEE
Title or Position: OWNER
Credential:
Phone: 323-957-9777