=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215104021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT ADULT DAY HEALTH CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2008
-----------------------------------------------------
Last Update Date | 05/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5500 VALLEY BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90032-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-223-0881
-----------------------------------------------------
Fax | 323-222-0478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5500 VALLEY BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90032-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-223-0881
-----------------------------------------------------
Fax | 323-222-0478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MISS WEN CHENG
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 323-223-0881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 060000770
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------