Healthcare Provider Details

I. General information

NPI: 1013124072
Provider Name (Legal Business Name): WELL AND FIT ADULT DAY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MERCURY CIRCLE
POMONA CA
91768
US

IV. Provider business mailing address

105 MERCURY CIRCLE
POMONA CA
91768
US

V. Phone/Fax

Practice location:
  • Phone: 909-860-0061
  • Fax: 909-860-6801
Mailing address:
  • Phone: 909-860-0061
  • Fax: 909-860-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000858
License Number StateCA

VIII. Authorized Official

Name: MR. WALTER PAO
Title or Position: PRESIDENT
Credential:
Phone: 909-860-0061