Healthcare Provider Details

I. General information

NPI: 1508227893
Provider Name (Legal Business Name): SUPPORTIVE CARE SERVICES FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 ARIZONA ST # 104
WESTMINSTER CA
92683-3951
US

IV. Provider business mailing address

13800 ARIZONA ST # 104
WESTMINSTER CA
92683-3951
US

V. Phone/Fax

Practice location:
  • Phone: 714-439-9999
  • Fax: 714-242-2002
Mailing address:
  • Phone: 714-439-9999
  • Fax: 714-242-2002

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: MS. CAROLYNN NGUYEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-439-9999