Healthcare Provider Details

I. General information

NPI: 1255850814
Provider Name (Legal Business Name): MAGNOLIA ADULT DAY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W 15TH ST
SANTA ANA CA
92701-2307
US

IV. Provider business mailing address

202 HOSPITAL CIR
WESTMINSTER CA
92683-3910
US

V. Phone/Fax

Practice location:
  • Phone: 657-210-2379
  • Fax:
Mailing address:
  • Phone: 714-894-5880
  • 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: GINA TRUONG
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 714-894-5880