=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235799339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRENCH VALLEY ADHC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2019
-----------------------------------------------------
Last Update Date | 06/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11256 CANDLEBERRY CT
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128-3612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-573-0718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11256 CANDLEBERRY CT
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128-3612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-573-0718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MISS ABIGAIL PEROS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-573-0718
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------