Healthcare Provider Details

I. General information

NPI: 1396964110
Provider Name (Legal Business Name): KHEIR MIRAE ADULT DAY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 11/04/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S WESTERN AVE.
LOS ANGELES CA
90005-3113
US

IV. Provider business mailing address

3727 W 6TH ST STE 210
LOS ANGELES CA
90020-5108
US

V. Phone/Fax

Practice location:
  • Phone: 213-427-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000909
License Number StateCA

VIII. Authorized Official

Name: ERIN PAK
Title or Position: CEO - ADHC ADMINISTRATOR
Credential:
Phone: 213-427-4000