Healthcare Provider Details

I. General information

NPI: 1841774080
Provider Name (Legal Business Name): WEST COVINA ADULT DAY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CAMERON AVE STE 100
WEST COVINA CA
91790-2724
US

IV. Provider business mailing address

7811 COMMONWEALTH AVE
BUENA PARK CA
90621-2422
US

V. Phone/Fax

Practice location:
  • Phone: 714-512-0016
  • Fax:
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: KAWON LEE
Title or Position: EXECUTIVE DIRECTOR / ADMINISTRATOR
Credential:
Phone: 714-512-0016