Healthcare Provider Details

I. General information

NPI: 1568659977
Provider Name (Legal Business Name): POWAY ADULT DAY HEALTH CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2007
Last Update Date: 09/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13180 POWAY RD
POWAY CA
92064-4612
US

IV. Provider business mailing address

10923 CAMINITO TIERRA
SAN DIEGO CA
92131-3569
US

V. Phone/Fax

Practice location:
  • Phone: 858-748-5044
  • Fax: 858-748-5405
Mailing address:
  • Phone: 858-748-5044
  • Fax: 858-748-5405

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: MRS. KATHRYN FAYE HOLT
Title or Position: MANAGING MEMBER
Credential: B.A., M.A.
Phone: 858-748-5044