Healthcare Provider Details

I. General information

NPI: 1457617748
Provider Name (Legal Business Name): SENIOR CARE AND DEVELOPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 EAGLE ROCK BLVD
LOS ANGELES CA
90041-3395
US

IV. Provider business mailing address

4515 EAGLE ROCK BLVD
LOS ANGELES CA
90041-3395
US

V. Phone/Fax

Practice location:
  • Phone: 323-712-8523
  • Fax:
Mailing address:
  • Phone: 323-712-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000936
License Number StateCA

VIII. Authorized Official

Name: MRS. GREGORIA VALIENTE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 323-712-8523