Healthcare Provider Details

I. General information

NPI: 1629735089
Provider Name (Legal Business Name): CHURCH ADULT DAY HEALTH CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 LINDLEY AVE
TARZANA CA
91356-1723
US

IV. Provider business mailing address

5955 LINDLEY AVE
TARZANA CA
91356-1723
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-5173
  • Fax: 818-996-6467
Mailing address:
  • Phone:
  • 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: MR. GEORGE BET RASHO
Title or Position: DIRECTOR
Credential:
Phone: 818-996-5173