Healthcare Provider Details

I. General information

NPI: 1376690909
Provider Name (Legal Business Name): CLAIREMONT VILLA ADULT DAY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10174 OLD GROVE RD STE 100 STE. 101
SAN DIEGO CA
92131
US

IV. Provider business mailing address

10174 OLD GROVE RD STE 100 STE 101
SAN DIEGO CA
92131
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-8575
  • Fax: 858-576-8424
Mailing address:
  • Phone: 858-576-8575
  • Fax: 858-576-8424

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: ALEXANDER AVERGOON
Title or Position: CEO/OWNER
Credential:
Phone: 858-337-5483