Healthcare Provider Details

I. General information

NPI: 1861680183
Provider Name (Legal Business Name): ULTRALIFE SENIOR CARE PLANNING COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S NEW AVE 1022 EAST GARVEY AVE
MONTEREY PARK CA
91755-3032
US

IV. Provider business mailing address

101 S NEW AVE 1022 EAST GARVEY AVE
MONTEREY PARK CA
91755-3032
US

V. Phone/Fax

Practice location:
  • Phone: 626-307-8806
  • Fax: 606-307-8808
Mailing address:
  • Phone: 626-307-8806
  • Fax: 606-307-8808

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: MS. CYBELE LEE
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-307-1113