Healthcare Provider Details

I. General information

NPI: 1245540426
Provider Name (Legal Business Name): GARDNER ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N JACKSON AVE
SAN JOSE CA
95116-1907
US

IV. Provider business mailing address

130 N JACKSON AVE
SAN JOSE CA
95116-1907
US

V. Phone/Fax

Practice location:
  • Phone: 408-918-2682
  • Fax: 408-278-7799
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number070000200
License Number StateCA

VIII. Authorized Official

Name: OFELIA RUIZ
Title or Position: DIRECTOR
Credential:
Phone: 408-935-3971