Healthcare Provider Details

I. General information

NPI: 1831670462
Provider Name (Legal Business Name): OPICA ADULT DAY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11759 MISSOURI AVE
LOS ANGELES CA
90025-1865
US

IV. Provider business mailing address

11759 MISSOURI AVE
LOS ANGELES CA
90025-1865
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-0226
  • Fax: 310-478-2026
Mailing address:
  • Phone: 310-478-0226
  • Fax: 310-478-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number191603551
License Number StateCA

VIII. Authorized Official

Name: MARY MICHLOVICH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-478-0226