Healthcare Provider Details

I. General information

NPI: 1306064134
Provider Name (Legal Business Name): CASA DE ORO ADHC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 CAMPO RD STE 130
SPRING VALLEY CA
91977-1400
US

IV. Provider business mailing address

9805 CAMPO RD STE 130
SPRING VALLEY CA
91977-1400
US

V. Phone/Fax

Practice location:
  • Phone: 619-462-0881
  • Fax: 619-462-0084
Mailing address:
  • Phone: 619-462-0881
  • Fax: 619-462-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000891
License Number StateCA

VIII. Authorized Official

Name: SHERI MCFADDEN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 619-462-0881