Healthcare Provider Details

I. General information

NPI: 1043715436
Provider Name (Legal Business Name): FRIENDSHIP ADULT DAY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 EUCALYPTUS LN
SANTA BARBARA CA
93108-2901
US

IV. Provider business mailing address

89 EUCALYPTUS LN
SANTA BARBARA CA
93108-2901
US

V. Phone/Fax

Practice location:
  • Phone: 805-969-0859
  • Fax: 805-565-3828
Mailing address:
  • Phone: 805-969-0859
  • Fax: 805-565-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number425801731
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number421701581
License Number StateCA

VIII. Authorized Official

Name: MS. TRACY SAMANTHA COHN
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-969-0859