Healthcare Provider Details

I. General information

NPI: 1073163119
Provider Name (Legal Business Name): GENTLE HEART DAYCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E HOLT AVE
POMONA CA
91767-5817
US

IV. Provider business mailing address

1275 E HOLT AVE
POMONA CA
91767-5817
US

V. Phone/Fax

Practice location:
  • Phone: 626-592-5999
  • Fax:
Mailing address:
  • Phone: 626-592-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. NELLIE N QIN
Title or Position: OWNER
Credential:
Phone: 626-592-5999