Healthcare Provider Details

I. General information

NPI: 1346347697
Provider Name (Legal Business Name): MAYFAIR ADULT DAY HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 W 20TH ST
LOS ANGELES CA
90007-1102
US

IV. Provider business mailing address

1627 W 20TH ST
LOS ANGELES CA
90007-1102
US

V. Phone/Fax

Practice location:
  • Phone: 323-299-8788
  • Fax: 323-299-8726
Mailing address:
  • Phone: 323-766-5363
  • Fax: 323-766-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000718
License Number StateCA

VIII. Authorized Official

Name: MS. LYUDMILA PRUDKOV
Title or Position: PRESIDENT
Credential:
Phone: 323-766-5363