=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205099025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAR COMMUNITY ADHC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2008
-----------------------------------------------------
Last Update Date | 03/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4410 NORTH PECK RD
-----------------------------------------------------
City | SOUTH EL MONTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-450-0700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4410 NORTH PECK RD
-----------------------------------------------------
City | SOUTH EL MONTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-450-0700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | HERBERT HO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-607-8381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 060000840
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------