Healthcare Provider Details

I. General information

NPI: 1396201828
Provider Name (Legal Business Name): SPECTRUM ADULT DAY HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 11/01/2022
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4428 CONVOY ST STE 288
SAN DIEGO CA
92111-3761
US

IV. Provider business mailing address

5770 BELLEVUE AVE
LA JOLLA CA
92037-7303
US

V. Phone/Fax

Practice location:
  • Phone: 802-430-7543
  • Fax: 856-724-3302
Mailing address:
  • Phone: 858-952-8531
  • Fax: 858-724-3302

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: MR. GARY POLSKY
Title or Position: OWNER
Credential:
Phone: 858-952-8531