Healthcare Provider Details

I. General information

NPI: 1275170136
Provider Name (Legal Business Name): THE GEORGE G. GLENNER ALZHEIMER'S FAMILY CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 4TH AVE
SAN DIEGO CA
92103-4106
US

IV. Provider business mailing address

2765 MAIN ST STE A
CHULA VISTA CA
91911-4846
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-4704
  • Fax: 619-543-5145
Mailing address:
  • Phone: 619-543-4700
  • Fax: 619-295-1034

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: SCOTT TARDE
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential:
Phone: 619-543-4700