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General NPI Number Information
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NPI Number | 1164952545
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Entity Type | Organization
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Legal Business Name | ADELANTO LOVING CARE INC.
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15093 ARCADIAN ST
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City | ADELANTO
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State | CA
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Zip | 92301-6111
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Country | US
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Telephone | 760-565-9304
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Fax | 760-523-1447
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Provider Business Mailing Address
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Address Line | 15093 ARCADIAN ST
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City | ADELANTO
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State | CA
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Zip | 92301-6111
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Country | US
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Telephone | 760-565-9304
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Fax | 760-523-1447
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN TSIMOGIANIS
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Credential |
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Telephone | 760-565-9304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 366426090
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License Number State | CA
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