Healthcare Provider Details

I. General information

NPI: 1558902767
Provider Name (Legal Business Name): HEALTH ALLIANCE ADHC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 N GAREY AVE
POMONA CA
91767-1308
US

IV. Provider business mailing address

1245 W CIENEGA AVE SPC 106
SAN DIMAS CA
91773-2826
US

V. Phone/Fax

Practice location:
  • Phone: 800-420-2356
  • Fax: 800-420-0481
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 State

VIII. Authorized Official

Name: JOSE E DE CASTRO
Title or Position: PRESIDENT
Credential:
Phone: 626-216-8999