Healthcare Provider Details

I. General information

NPI: 1689133621
Provider Name (Legal Business Name): LUCKY STARS ADULT DAY HEALTH CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19715 COLIMA RD UNIT B
ROWLAND HEIGHTS CA
91748-3211
US

IV. Provider business mailing address

8300 UTICA AVE STE 300
RANCHO CUCAMONGA CA
91730-3852
US

V. Phone/Fax

Practice location:
  • Phone: 909-957-9995
  • Fax:
Mailing address:
  • Phone: 909-957-9995
  • 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: TAMMY WANG
Title or Position: ADMINISTRATOR
Credential: MS, RD, CCS,
Phone: 909-655-6168