Healthcare Provider Details

I. General information

NPI: 1124242664
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 SAN ANTONIO DR
NORWALK CA
90650-4335
US

IV. Provider business mailing address

415 TENNESSEE ST
REDLANDS CA
92373-8168
US

V. Phone/Fax

Practice location:
  • Phone: 562-929-4345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: LES SPOELSTRA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 909-335-0840