Healthcare Provider Details

I. General information

NPI: 1871705020
Provider Name (Legal Business Name): BE WELL ADULT DAY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10925 COLUMBUS AVE
MISSION HILLS CA
91345-1511
US

IV. Provider business mailing address

10925 COLUMBUS AVE
MISSION HILLS CA
91345-1511
US

V. Phone/Fax

Practice location:
  • Phone: 818-837-8285
  • Fax: 818-837-8245
Mailing address:
  • Phone: 818-837-8285
  • Fax: 818-837-8245

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: IGOR DAVID MOLCHANOV
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-837-8285