Healthcare Provider Details

I. General information

NPI: 1699873471
Provider Name (Legal Business Name): EVERLASTING ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 EAGLE ROCK BLVD
LOS ANGELES CA
90041-3214
US

IV. Provider business mailing address

4515 EAGLE ROCK BLVD
LOS ANGELES CA
90041-3214
US

V. Phone/Fax

Practice location:
  • Phone: 323-433-3525
  • Fax: 323-344-3501
Mailing address:
  • Phone: 323-433-3525
  • Fax: 323-344-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. OSCAR LICTAOA JORNACION
Title or Position: CHAIRMAN OF THE BOARD
Credential: CPA MBA
Phone: 323-433-3521