Healthcare Provider Details

I. General information

NPI: 1205099025
Provider Name (Legal Business Name): STAR COMMUNITY ADHC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 NORTH PECK RD
SOUTH EL MONTE CA
91732
US

IV. Provider business mailing address

4410 NORTH PECK RD
SOUTH EL MONTE CA
91732
US

V. Phone/Fax

Practice location:
  • Phone: 626-450-0700
  • Fax:
Mailing address:
  • Phone: 626-450-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000840
License Number StateCA

VIII. Authorized Official

Name: HERBERT HO
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 626-607-8381